Small-fragment wounds from explosive devices: need for and timing of fragment removal

The management of soft tissue small-fragment wounds caused by bombs remains controversial. The authors analyzed the outcome of low-energy foreign body injuries in 10 pediatric victims of suicide bomber attacks treated in their institution over a 2-year period. Two died during primary surgery. The eight survivors underwent a total of 10 procedures for removal of foreign bodies. Average follow-up was 24.1 months. The indications for the procedures were analyzed by the time of their performance: immediate, as part of the primary emergency operation (n = 2); intermediate, within 2 weeks after injury (n = 3); and late, more than 2 weeks after injury (n = 5). The results showed that all operations performed for objective indications were done within the immediate or intermediate period, whereas those done for subjective reasons were all but one performed in the late period. By the final follow-up visit, all foreign bodies had been removed. In conclusion, fragment removal is best done during the primary procedure if it does not pose a significant risk of complications.