Management of small fragment wounds: Experience from the Afghan border
Management of small fragment wounds: Experience from the Afghan border
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DOI：
10.1097/00005373-199603001-00037
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发表时间：
1996-03-01
影响因子：
--
通讯作者：
Bowyer, GW
中科院分区：
文献类型：
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作者：
Bowyer, GW
在最近的冲突中，弹药碎片造成了大多数伤亡，这些伤口往往是多重的，许多只影响到四肢的软组织。这些伤口的处理是有争议的；一些外科医生提倡积极的手术治疗；另一些人则认为，在某些情况下，非手术治疗是合适的。红十字国际委员会在治疗战争创伤方面有丰富的经验，它在靠近阿富汗边境的巴基斯坦设有一所战争外科医院，接收阿富汗持续冲突中的伤员。本文描述了1200多例碎片伤的数量、分布和严重程度，这些伤是在最近一次战斗爆发期间被送到医院的83名伤亡人员造成的。大部分碎片伤都在四肢上。我们对仅影响皮肤和肌肉的小碎片伤口进行了非手术治疗，使用了抗生素和敷料，850多处伤口采用了这种方法，在63例伤病员中，只有2例出现了并发症，并发症是局部脓肿，其中1例需要手术引流，仔细评估伤口和保守治疗选择伤口的政策似乎都取得了成功。从节省手术资源、安全、无危及生命或肢体的并发症的角度出发，本文对哪些伤口可能适合非手术治疗提出了建议，但承认需要进一步的工作来确定这些常见伤口的最佳治疗方法。
Fragmenting munitions have caused the majority of casualties in recent conflicts, These wounds are often multiple, many affecting only the soft tissues of the extremities. The management of these wounds is controversial; some surgeons advocate aggressive surgical treatment; others believe that a nonoperative policy is appropriate in selected cases. The International Committee of the Red Cross has a great deal of experience in treating the wounds of war, It maintains a war surgery hospital in Pakistan, close to the Afghan border, receiving wounded from the ongoing conflict in Afghanistan, This paper describes the number, distribution, and severity of more than 1200 fragment wounds, These injuries were sustained by 83 casualties who presented to the hospital during a recent flare-up in the fighting, The majority of these fragment wounds affected the limbs. Small-fragment wounds affecting only the skin and muscle were managed nonoperatively, with antibiotics and dressings, More than 850 wounds were managed in this way, There were complications in only two of the 63 casualties who had wounds that were treated nonoperatively, The complications were localized abscesses, one of which required surgical drainage, The policy of carefully assessing the wounds and treating selected wounds conservatively appears to have been both successful, in terms of saved surgical resources, and safe, with no life- or limb-threatening complications, This paper makes recommendations as to which wounds might be suitable for nonoperative management, but acknowledges that further work is needed to define the optimal treatment of these common wounds.