Musculoskeletal war wounds during Operation BRAVA in Sri Lanka

Operation BRAVA (Blast Resuscitation and Victim Assistance) was conceived as a means of conducting humanitarian assistance, education, and training in the acute surgical management of land mine and other blast injuries. The first Operation BRAVA mission was carried out in Sri Lanka during 1998 at a time of civil war between government forces and Tamil separatists. Thirty-seven patients with orthopedic war wounds were seen during this mission because of the fighting. Exploding ordnance injured 24 patients (65%), and 13 patients (35%) sustained gunshot wounds. Sixty-seven percent of explosive injuries were from mortar rounds, and the remainder was from a variety of detonating munitions. Twenty-two patients (59%) sustained injuries to one or both lower limbs, and compartment syndrome of the leg developed in two of these patients as a result of multiple fragment injuries. Nine patients (24%) sustained concomitant neurological or vascular injuries. Operation BRAVA provided a novel approach to enhancing the combat medical skills of U.S. military personnel and was successful in developing working relationships with host country medical professionals, facilitating participation in the care of wounded patients, and establishing a framework upon which future BRAVA teams might build.