PENETRATING THORACOABDOMINAL WAR INJURIES

Background. From April 1991 till December 1995, Split University Hospi tal played a major role as a third echelon war hospital during the war in Croatia and Bosnia and Herzegovina, Among 2856 treated battle casu alties in general, 70 patients with penetrating thoraco-abdominal war injuries were treated at the Department of Surgery, Explosive wounds w ere present in 38 (54%), gunshot wounds in 32 (45%) and puncture wound s in four (5.70%) patients. Methods. The medical data from the evacuat ion unit, transportation, emergency department, surgical management an d follow-up were obtained and analyzed, The principle of treatment of such patients is described, with particular reference to thoracophreno laparotomy as the most efficient diagnostic-therapeutic surgical appro ach. Results. There were considerably more explosive wounds than gunsh ot and puncture wounds (ratio 38/32/4). Resource utilization analysis showed a great amount of blood products (average 1.250 ml per patient) , rehydrant solutions (average 3.750 ml per patient) and seven days an timicrobial chemoprophylaxis (penicillin, gentamycin, metronidazole) u sed, Mean time elapsed between injury and definitive surgical repair w as seven hours (range, 1 to 48 hours), Recovery on discharge was recor ded in 61 (80%) and lethal outcome in nine (13%) patients. Conclusions . The treatment of respiratory insufficiency and hemorrhagic shock, an d prevention of infection are the basis of the management of these inj uries, Treatment success depends on emergency first-aid, quick transpo rtation, early diagnosis, resuscitation, surgical therapy and intensiv e care.