Removal of unexploded ordnance from patients: A 50-year military experience and current recommendations

Background: Retained unexploded ordnance in a patient presents the surgeon with unique emotional and technical challenges. This report is a compilatio n of data to determine management strategies for these potentially catastro phic injuries. Methods: All identified military cases from World War II to the present were reviewed. Cases were reviewed for site of injury, type of munition, personnel and equipment precautions, and outcome. Interviews were conducted with available involved surgeons. Results: Thirty-six patients w ere identified with retained ordnance. Four were moribund upon arrival and died before operation. All of the remaining 32 patients survived the remova l of the unexploded ordnance. Thirteen injuries involved the trunk, 4 invol ved the head and neck, and 18 involved extremities. The majority of missile s (51%) were 40-mm projectiles. No incident was identified in which a round exploded during transportation, preparation, or removal. Explosive Ordinan ce Disposal assistance was available to the surgical team for all but one p atient during and after the Vietnam War. Measures used to reduce the chance of premature explosion are discussed. Conclusions: Isolation of the operat ing room and protection of personnel and equipment are essential. Patients should be triaged in the delayed category, because most are not moribund on arrival and all patients operated on survived. Explosive Ordnance Disposal expertise should be used. Knowledge of and adherence to several basic prin ciples will protect personnel and equipment while permitting optimal patien t care.