War wounds: Lessons learned from Operation Iraqi Freedom

Background: This study reports the experience of the plastic surgery department at Naval Medical Center San Diego in treating wounds resulting from combat during Operation Iraqi Freedom. Introduction of new technology and modification of medical treatments have emerged to provide greater success in preserving life and limb. Methods: The authors conducted a retrospective review of all Navy and Marine Corps casualties treated by the authors' department between April of 2003 and December of 2005. All medical information surrounding the patients' treatment and medivac rosters were used to collect the data. Results: The authors treated 68 patients, who underwent 240 operations. The age distribution was consistent with military enlistments (19 to 38 years). The majority of injuries were from blast (55 percent) and gunshot wounds (19 percent). The extremities were the site of injury in 9.1.2 percent of patients, with lower extremity wounds outnumbering upper extremity wounds approximately 2:1. The authors' wound management technique incorporated an aggressive surgical and antibiotic protocol, antibiotic-impregnated beads, and wound vacuum-assisted closure. The authors' limb salvage rate was high at 93.6 percent, with three amputations performed for flap failure. The acute osteomyelitis rate was 24.2 percent and the chronic osteomyelitis rate was 1.6 percent. Conclusions: The authors' results reflect a higher limb salvage rate than that achieved during previous wars. They feel their success was attributable to the use of wound vacuum-assisted closure, an aggressive surgical approach, and appropriate antibiotic therapy. Wound vacuum-assisted closure is the single intervention that is new among the authors' choices of techniques for treating combat wounds.