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The Scope of Wounds Encountered in Casualties From the Global War on Terrorism: From the Battlefield to the Tertiary Treatment Facility

Dr. Mazurek is Director, Orthopaedic Trauma, Naval Medical Center, San Diego, CA, and Orthopaedic Trauma Advisor, US Navy Orthopaedic Specialty Leader. Dr. Ficke is Chief, Orthopaedic Surgery Service, Brooke Army Medical Center, Fort Sam Houston, TX, and Orthopaedic Consultant, US Army Surgeon General.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Mazurek and Dr. Ficke.

The views expressed in this paper are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of the Army, Department of Defense, or the United States Government.

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.

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