Principles of war surgery: current concepts and future perspectives

Medical support is an important part of military operations. The aim of war surgery is to achieve the return of the greatest number of injured to combat and the preservation of life, limb, and eyesight. War surgery is different from current traumatology because of many reasons. Because hemorrhage is the most common cause of death in military trauma, airway preservation and effective control of bleeding represent the highest priorities in war injuries. Wound excision (the so-called debridement) is a significant part in the management of war injuries. It involves excision of all foreign objects and contaminants and dead/nonviable tissue that--if not removed--would become a medium for infection. Broad-spectrum antibiotics should be administered and tetanus prophylaxis measures should be taken, as indicated. Delayed wound closure (usually after 4-5 days) is the standard procedure after wound excision. Recently, changes in the dogma of war necessitated significant changes in the organization schema of military services supporting modern military operations. The concept of highly mobile, easily deployed, forward surgical facilities is the most important change in the philosophy of modern war injury. Military surgeons are now facing new challenges; appropriate education is required to achieve success in their mission.