Medical Consequences and Treatment of Injuries Caused by White Phosphorus Munitions

Abstract

White phosphorus (WP) has been used in hand grenades, mortar and artillery shells, and aerial bombs since World War I. Recently it has been used in combat operations in Iraq, Syria, Afghanistan, Yemen, Nagorno-Karabakh and is used during the Palestinian-Israeli conflict in Gaza. Burns caused by WP usually result in death or disability. The purpose of the work is to analyze and summarize the data of the scientific literature on the medical consequences and treatment of lesions caused using ammunition with WP. Materials and methods. For the analysis, we used available scientific publications describing the consequences of WP burns received during hostilities. The method of analysis is descriptive. The following tasks were solved: the properties of WP as a damaging agent were studied; materials on the medical consequences of WP lesions and methods of treatment of such lesions were summarized. Discussion of the results. WP is highly reactive, highly toxic and ignites in air as early as 35°C. The severity of WP lesions is the result of both the thermal and chemical effects of combustion. Fatalities among humans from WP burns have occurred involving less than 10% of the total body surface area. Burns caused by WP heal more slowly than thermal burns. WP penetrates deeply through the fatty subcutaneous tissue. Therefore, the burns are full-thick, necrotic. The absorbed WP acts as a cellular poison and causes damage to the central nervous system, liver, kidneys, myocardium, and other organs. Any WP particles trapped in the wound may re-ignite. Conclusion. At the pre-hospital stage, the first thing to do is to wash off the wounds with cool water and remove the pieces of WP that have fallen into the skin with forceps. The light from the UV lamp can help to visualize the small particles of WP. Cleaning exfoliated skin and removing visible WP particles from the skin are critical methods for limiting wound severity and systemic WP absorption. It is advisable to excise the burned area within an hour after the lesion and repeat surgical procedures until all phosphorus particles have been removed; to control during the first 48 hours for the content of calcium and phosphorus in the blood serum with appropriate correction. In the future, skin grafting and treatment with allogeneic mesenchymal stem cells are advisable.