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Flail Chest-II

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Penetrating Axilla Injuries and Ceramic Plate Coverage: A Special Operations Case Series.

Duncan Mark Carlton^1,2, Alexandre Nguyen^1,2, Nicholas Warner³

¹Naval Medical Training Center, San Diego, CA.

Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals

|September 15, 2025

Summary

This summary is machine-generated.

Four-plate body armor significantly reduces mortality from penetrating axilla injuries compared to older systems. Improved side-plate coverage is needed to protect against thoracic cavity violations and enhance casualty survival.

Keywords:

axilla ballistic plates body armor combat injury exsanguination gunshot wound mediastinal injury military trauma transmediastinal gunshot wound

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Area of Science:

Military medicine
Trauma surgery
Ballistics

Background:

Body armor has evolved to reduce battlefield injuries over two decades.
Penetrating axilla injuries remain a significant challenge despite advanced armor.
Current armor efficacy against axilla trauma requires further investigation.

Purpose of the Study:

To evaluate the effectiveness of current body armor configurations in mitigating axilla injury mortality and morbidity.
To compare the outcomes of axilla injuries sustained with different body armor systems.

Main Methods:

Retrospective case series analysis of after-action reports from a Special Operations unit (2001-2018).
Screening of 786 records to identify 11 cases meeting inclusion criteria for axilla injuries.
Data collection on injury patterns, body armor type, clinical interventions, and patient outcomes.

Main Results:

A 45% mortality rate was observed for axilla injuries.
100% mortality occurred in cases with uncovered side-plate regions under a two-plate system.
No fatalities were recorded when injuries occurred within the protected side-plate regions of a four-plate system, highlighting its protective benefit against thoracic cavity violations.

Conclusions:

Four-plate body armor systems demonstrate superior efficacy in reducing mortality from axilla injuries compared to older configurations.
Existing side-plate coverage has limitations, particularly superiorly, indicating potential protection gaps.
Future research should focus on enhancing ballistic protection and trauma management protocols for improved operational agility and casualty outcomes.