War wounds: lessons learned from Operation Iraqi Freedom.

Area of Science:

• Plastic Surgery
• Combat Medicine
• Trauma Surgery

Background:

• Experience of plastic surgery department at Naval Medical Center San Diego treating combat wounds during Operation Iraqi Freedom.
• Introduction of new technology and modified medical treatments for improved life and limb preservation.

Purpose of the Study:

• To report the experience and outcomes of treating combat wounds.
• To evaluate the effectiveness of novel wound management techniques.

Main Methods:

• Retrospective review of Navy and Marine Corps casualties treated between April 2003 and December 2005.
• Data collected from patient treatment information and medivac rosters.

Main Results:

• 68 patients underwent 240 operations; injuries primarily from blast (55%) and gunshot wounds (19%).
• Extremity injuries (91.2%) predominantly affected lower limbs.
• Limb salvage rate was 93.6% using aggressive surgical protocols, antibiotics, antibiotic-impregnated beads, and wound vacuum-assisted closure (V.A.C.).
• Acute osteomyelitis rate was 24.2%, chronic osteomyelitis rate was 1.6%.

Conclusions:

• Higher limb salvage rate achieved compared to previous wars.
• Success attributed to wound V.A.C., aggressive surgery, and antibiotic therapy.
• Wound V.A.C. identified as a novel and key intervention.