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AAPS 85th Annual Meeting
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War Wounds: Lessons Learned from Operation Iraqi Freedom
Scott E. Geiger, MD, Frank McCormick, MD, Richard Chou, MD, Craig Salt, MD, James Amsberry, MD, Amy Wandel, MD.
Naval Medical Center San Diego, San Diego, CA, USA.

PURPOSE: The purpose of this study was to retrospectively evaluate all Navy and Marine Corp Casualties treated operatively at Naval Medical Center San Diego Plastic Surgery Department from April 2003 through October 2005 and review mechanisms of injury, sites of injury, the use of wound vacuums, flaps and skin grafts, and challenges of managing the injured soldier.
METHODS: A retrospective review was performed using hospital admission charts, inpatient and outpatient records, OR logs, supply lists, and medivac rosters. Data was categorized and analyzed, then individual cases were identified for elaboration on successes, advances, and any general “Lessons Learned.”
RESULTS: Data analyzed reveals 82 patients undergoing 158 total operations. Combat injuries accounted for 76% wounds. Mechanisms of injury were primarily Blast (55%), followed by GSWs (19%), Blunt (16%), and Burn (10%). Extremity and multiple sites were the primary injury distributions (68%, 19%). Wound vacuums were used on 41% of our patients for an average of 12 days (range 1-39), and found application while in theatre to definitive treatment. Long pedicle flaps and vein grafts were essential in managing the large zones of injury.
CONCLUSION: The theater of war has long been a source for advancements in surgical knowledge and application. Application of microsurgical techniques and advances in pre-surgical management such as the use of Vacuum Assisted Closure devices have vastly improved our ability to care for injured soldiers, including preservation of limbs, restoration of function, and improved appearance. Future research on quality of life with limb salvage versus amputation is needed.

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