Wartime Amputations

Abstract

This paper outlines the causative factors, incidence, and localization of extremity amputations of wounded persons treated at the Osijek University Hospital (Eastern Slavonia) during 1991 and 1992. The medical documentation of 5,024 patients was analyzed. Of these, 1,560 patients were treated in the hospital (31.0%). A total of 1,916 extremity injuries were found in hospitalized wounded patients. Injuries of the lower extremities were found in 1,226 patients and injuries of the upper extremities in 690 patients. Gunshot-explosive fractures of the extremity bones were diagnosed in 1,122 patients (71.9%): 735 (47.1%) in the lower extremities and 387 (25.8%) in the upper extremities. In 90 cases (4.6%), amputation of the extremities (including the fingers) using an open circular or flap technique was performed. Large amputations (above the wrist and ankle joints) were performed on 40 patients (2.6%). Amputation of the upper extremities was performed on 53 patients (58.9%), and amputation of the lower extremities was performed on 37 patients (41.1%). Injuries of the major blood vessels were treated with primary reconstruction in the upper extremities in 44 patients and in the lower extremities in 96 patients. Unstable gunshot-explosive fractures of the long bones were stabilized with external fixation, and fractures of the short bones were stabilized by means of minimal osteosynthesis or external fixation. Secondary amputations (on the lower extremities) were performed on 2 patients because of vascular insufficiency. Not a single secondary amputation procedure was performed because of infection, secondary uncontrolled hemorrhage, or gas gangrene. Amputation is a radical and irreversible intervention, and indications for amputation must be determined by those with great surgical experience and good knowledge of military-surgical doctrine.

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

“…Both cases were in the placebo group: none was observed in either the cephalothin or the penicillin plus aminoglycoside arm. Currently, clostridial infections of open fractures are rare, even under battlefield conditions [119,120]. Nonetheless, many texts have quoted the suggestion of Patzakis et al that penicillin G should be used as clostridial prophylaxis in selected wounds [43,121].…”

Extremity Vascular Injuries on the Battlefield: Tips for Surgeons Deploying to War

“…26 Debridement amputation is preferred and can be followed several days later by staged primary amputation after the wound has been controlled. Principles of debridement amputation include preservation of as much length as is safely feasible, suture ligation of major, named vascular structures away from contaminated fields with appropriate muscle or soft tissue coverage of the vascular stump, debridement of devitalized skin, muscle, fat and bone and evacuation and cleansing of particulate matter such as dirt, concrete and wood.…”

A method for determining the rate of major limb amputations in battle casualties: Experiences of a British Field Hospital in Iraq, 2003

“…Our commonest MOI, due to fragmentation injuries, is mirrored by others. 5,11 Despite some observed similarities regarding type and mechanism of injuries, the lack of a uniform definition of major limb amputation rate makes it difficult for meaningful comparisons to be made relating to this, a relatively common procedure in war. A reliable amputation rate could be valuable as an index to reflect the severity of wounding among battle casualties and hence act as a guide to plan surgical/medical support in a conflict zone.…”

“…Jovanic and colleagues, in their paper relating to the war in Croatia, quote an amputation rate of nearly 5%. 5 Their definition included minor amputations such as digital amputations, in calculating the amputation rate.…”