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.