Treatment of Musculoskeletal Blast Wounds at a Navy Field Hospital during the Balkans War

Summary: Twenty-two patients with blast wounds of the spine and extremities were treated at a Navy field hospital in the former Republic of Yugoslavia during a 6-month period in 1994. The injury spectrum ranged from jagged puncture wounds to traumatic amputations and massive soft tissue loss. All patients were managed with irrigation, debridement. and broad-spectrum antibiotics. One patient died as a result of his injuries (overall mortality 4.5%). There were six belowknee amputations in five patients, and one patient sustained a partial hand amputation. Sixteen patients (73%) had other injuries or conditions in addition to their orthopedic wounds. Three patient had Pseudomonas aeruginosa wound infections, and one of these patients had concomitant scpticemia. Pulmonary complications included adult respiratory distress syndrome in two patients and pneumonia in two patients. Our experience indicates that tissue damage resulting from blast fragments was qualitatively different from that caused by gunshot wounds. We found that early and meticulous debridement, leaving wounds open, and appropriately tailoring antibiotic therapy were key factors in providing the best opportunity for wound healing without infection.