Characteristics of Improvised Explosive Device Trauma Casualties in the Gaza Strip and Other Combat Regions: The Israeli Experience.
OBJECTIVE
Low-intensity conflict is characterized in asymmetrical conventional and nonconventional warfare. The use of improvised explosive devices (IEDs) in the Israeli-Palestinian conflict has evolved over the past few decades to include the addition of diesel, biological agents, shrapnel, and nitroglycerin to the explosive content. Due to its nature and mechanism, an IED injury might present as a multidimensional injury, impairing numerous systems and organs.


METHODS
The authors present a case series of 5 Israeli Defense Forces (IDF) soldiers wounded by an IED presenting a typical and similar pattern of burns to their faces, trunks, and limbs, in addition to ocular, ear/nose/throat, and orthopedic injuries. An analysis of the experience in treating the aforementioned injuries is included.


RESULTS
Improvement in casualties' burns and traumatic tattoos was observed following debridement, aggressive scrubbing with or without dermabrasion, and conservative local dressing treatment protocol. The authors found a positive correlation between improvement degree and treatment timing. Injury pattern was correlative to the protective gear worn by the soldiers. Wearing protective eye gear and wearing ceramic vests can diminish the extent of IED injuries, while creating typical patterns of injuries to be treated.


CONCLUSIONS
Based on these experiences, such injuries should be brought to a trauma center as soon as possible. Treating multidimensional trauma should be done in a facility with abilities to treat head injuries, eye injuries, penetrating injuries, blast injuries, and burns. Such specialized disciplines and facilities that have past experience with IEDs and war injuries are able to assess and treat these injuries in a more dedicated manner, resulting in better long-term rehabilitation.
Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel.
Liranr
L
Barzilai
Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel.
Moti
M
Harats
Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel; and 3Department of Surgery, A. Meir Medical Center, Kfar Saba, Israel.
Itay
I
Wiser
Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel.
Oren
O
Weissman
Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel.
Noam
N
Domniz
Department of Surgery, A. Meir Medical Center, Kfar Saba, Israel.
Elon
E
Glassberg
Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel.
Demetris
D
Stavrou
Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel.
Issac
I
Zilinsky
Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel.
Eyal
E
Winkler
Department of Plastic and Reconstructive Surgery and the Burn Unit, Sheba Medical Center, Tel Hashomer, Israel.
Josef
J
Hiak
D000328:Adult; D001753:Blast Injuries / Q000517:prevention & control / Q000628:therapy*; D054042:Bombs; D002056:Burns / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007557:Israel; D008297:Male; D008887:Military Medicine / Q000379:methods*; D008889:Military Personnel; D000067393:Personal Protective Equipment; D013997:Time Factors; D016896:Treatment Outcome; D014857:Warfare; D055815:Young Adult