MANAGEMENT OF SMALL FRAGMENT WOUNDS - EXPERIENCE FROM THE AFGHAN BORDER

Fragmenting munitions have caused the majority of casualties in recent conflicts, These wounds are often multiple, many affecting only the s oft tissues of the extremities. The management of these wounds is cont roversial; some surgeons advocate aggressive surgical treatment; other s believe that a nonoperative policy is appropriate in selected cases. The International Committee of the Red Cross has a great deal of expe rience in treating the wounds of war, It maintains a war surgery hospi tal in Pakistan, close to the Afghan border, receiving wounded from th e ongoing conflict in Afghanistan, This paper describes the number, di stribution, and severity of more than 1200 fragment wounds, These inju ries were sustained by 83 casualties who presented to the hospital dur ing a recent flare-up in the fighting, The majority of these fragment wounds affected the limbs. Small-fragment wounds affecting only the sk in and muscle were managed nonoperatively, with antibiotics and dressi ngs, More than 850 wounds were managed in this way, There were complic ations in only two of the 63 casualties who had wounds that were treat ed nonoperatively, The complications were localized abscesses, one of which required surgical drainage, The policy of carefully assessing th e wounds and treating selected wounds conservatively appears to have b een both successful, in terms of saved surgical resources, and safe, w ith no life- or limb-threatening complications, This paper makes recom mendations as to which wounds might be suitable for nonoperative manag ement, but acknowledges that further work is needed to define the opti mal treatment of these common wounds.