MANAGEMENT OF SMALL FRAGMENT WOUNDS IN WAR - CURRENT RESEARCH

The majority of war wounds are caused by antipersonnel fragments from munitions such as mortars and bomblets. Modern munitions aim to incapa citate soldiers with multiple wounds from very small fragments of low available kinetic energy. Many of these fragments may be stopped by he lmets and body armour and this has led to a predominance of multiple w ounds to limbs in those casualties requiring surgery. The development of an appropriate management strategy for these multiple wounds requir es knowledge of the contamination and extent of soft tissue injury; co nservative management may be appropriate. The extent of skin and muscl e damage associated with a small fragment wound, the way in which thes e wounds may progress without intervention and their colonisation by b acteria has been determined in an experimental animal model. Results f rom 12 animals are presented. There was a very small (similar to 1 mm) margin of nonviable skin around the entrance wound. The amount of dev italised muscle in the wound track was a few hundred milligrams. Some muscles peripheral to the wound track also showed signs of damage Ih a fter wounding, but this improved over 24 h; the proportion of fragment ed muscle fibres in the tissue around the track decreased as time went on. There was no clinical sign or bacteriological evidence of the tra ck becoming infected up to 24 h after wounding. This preliminary work suggests that, in the absence of infection, the amount of muscle damag e caused by small fragment wounds begins to resolve in the first 24 h after injury, even without surgical intervention.