Management of ballistic soft tissue injuries: a review

Abstract

Civilian populations are increasingly vulnerable to ballistic injuries resulting from firearms or from bomb blasts. Injuries of the extremities are most common with firearm- related violence and wounds of greater complexity are seen with explosive devices. Initial management is targeted to dealing with life-threatening conditions and stabilizing the patient followed by subsequent care in a well-equipped setting. In this paper, we review and discuss various management modalities specifically for ballistic soft tissue injuries which include conservative or surgical management, appropriate wound care, use of antibiotics and definitive management and reconstruction of soft tissue injuries. Initial evaluation can usefully classify the ballistic injury into a high- risk or a low-risk category and this influences subsequent management. Low-risk ballistic injuries can benefit from conservative non-surgical management. Experience acquired from the treatment of military ballistic wounds can be used in civilian settings especially in the case of wound debridement and use of antibiotics. Definitive management of soft tissue injuries usually involves the use of flaps for reconstruction. Keywords - ballistic injuries, reconstruction, soft tissue injuries, wound care