Surgical Care of Thermally Injured Patients on the Battlefield

Abstract

For young adults treated in burn centers in developed nations, the lethal area 50%—that is, the burn size lethal to one-half of a given population—has almost doubled since World War II from 43% of the total body surface area (TBSA) to 75% TBSA. This achievement reflects many factors, of which improvements in wound care, perioperative care, and surgical technique have figured prominently. The challenge deployed military health care providers face is how to translate these advances to the relatively austere and unforgiving environment of the combat zone. Thermal injuries are present in 5% to 20% of combat casualties. Thus, on the attlefield, role IIb (forward surgical teams) and role III (combat support hospitals) acilities frequently care for patients with burns. Most of these patients fall into two ategories: US military casualties and local national casualties. US military casualties ndergo emergency treatment and preparation for aeromedical evacuation to the nited States. Local national casualties, under the rules of engagement for the urrent conflicts in Iraq and Afghanistan, cannot be evacuated to the United States; hese patients must receive care locally. Because local resources in both theaters are imited, US field hospitals often are responsible for providing not only emergency reatment but also definitive care. Here, the author reviews the surgical care of atients with thermal injuries as it is practiced on the current battlefield. Conceptually, urn care can be divided into three distinct, albeit closely overlapping, phases: esuscitation, wound closure, and reconstruction. Operative management may be equired during each of these phases.