title: The scope of wounds encountered in casualties from the global war on terrorism: from the battlefield to the tertiary treatment facility.
abstract: Injuries seen in Operation Iraqi Freedom range from those that can be managed with nonsurgical wound care only to those requiring amputation or multiple bony and soft-tissue procedures for limb salvage. The contamination and soft-tissue injury caused by exploding ordnance requires an aggressive treatment approach. Severe wounds treated near the battlefield (ie, level II) require meticulous surgical débridement, early fracture stabilization, broad-spectrum antibiotics, and rapid evacuation. Treatment at a level III combat support hospital involves a greater volume of patients and a longer stay because of the presence of Iraqi national patients. In the authors' experience, most US patients requiring surgical treatment were evacuated to a level IV facility (ie, Landstuhl Regional Medical Center) after one or two surgeries. The basic war surgery principles of aggressive resuscitation, early and thorough débridement, short-duration damage-control surgical procedures, and rapid evacuation were critical in our reduction of wound infection rates to below 7% for all admissions.
authors.affiliation: Orthopaedic Trauma, Naval Medical Center, San Diego, CA, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Mazurek
authors.forename: James R
authors.initials: JR
authors.lastname: Ficke
mesh_terms: D006801:Humans; D054527:Mass Casualty Incidents / Q000706:statistics & numerical data*; D008887:Military Medicine / Q000458:organization & administration*; D013531:Surgicenters / Q000458:organization & administration*; D014481:United States; D014947:Wounds and Injuries / Q000628:therapy*