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Scope of Wounds

Dr. Crabtree is Chief, Department of Plastic Surgery, Tripler Army Medical Center, Tripler AMC, Hawaii.

Neither Dr. Crabtree nor the department with which he is 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.

The opinions or assertions contained herein are the private views of the author and are not to be construed as official or reflecting the views of the Department of Defense or United States Government. The author is an employee of the U.S. Government.

The scope of extremity wounds in the current conflict presents surgeons with new lessons to master. Unique to this conflict is a new type of patient, one with multiple and severely injured extremities who is otherwise free of serious injury. These injuries provide challenges to the medical system in terms of the volume and complexity of care, and to the patient and surgeon trying to achieve limb salvage and rehabilitation. These patients present with a combination of high-energy injury, massive evolving tissue destruction, and widespread contamination, resulting in an evolving zone of injury that respects no tissue planes, anatomic boundaries, or normal physiologic rules. We must ensure that our skills and techniques as surgeons evolve faster than do the injuries themselves.