Treatment Of War Wounds Research Articles

Experience and training needs of nurses in military hospital on emergency rescue at high altitude: a qualitative meta-synthesis

BackgroundNurses play an important role in the treatment of war wounds on the plateau, and they face multiple challenges and a variety of needs in their caregiving process. This study aimed to systematically integrate and evaluate qualitative research data to understand the altitude emergency rescue experience and training needs of nurses in military hospitals and provide them with targeted assistance.MethodsWe critically assessed the study using the Joanna Briggs Institute Critical Assessment Checklist for Qualitative Research. Extraction, summarization and meta-synthesis of qualitative data. Cochrane Library, PubMed, Embase, FMRS, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database, and China Biomedical Database (CBM) were searched for relevant studies published from the establishment of the database to May 2023. Additionally, we conducted a manual search of the references of the identified studies. Registered on the PROSPERO database (CRD42024537104).ResultsA total of 17 studies, including 428 participants, were included, and 139 research results were extracted, summarized into 10 new categories, and formed 3 meta-themes. Meta-theme 1: mental state of military nurses during deployment. Meta-theme 2: the experience of military nurses during deployment. Meta-theme 3: training needs for emergency care.ConclusionsEmergency rescue of high-altitude war injuries is a challenging process. Leaders should pay full attention to the feelings and needs of military nurses during the first aid process and provide them with appropriate support.

Risk factors and failures in the management of limb injuries in combat casualties.

Treatment of war wounds is based on a sequential surgical strategy, which frequently faces therapeutic failures, which then burden the final functional result. The aim of this study was to identify risk factors of failure of the different treatments to prevent the therapeutic failure. A monocentric case-control study was done on French war-wounded soldiers treated for an open fracture caused by an invasive war weapon. The primary end point was the treatment failure three months after the injury. The risk factors of failure studied were the traumatic mechanism, the general and local lesional assessment, and the surgery performed. Between January 1, 2004 and December 31, 2016, 57 soldiers were included, with an average follow-up of 3.42years. On 81 limb segments studied, the most injured segment was the leg (37.0%). A vital or urgent surgery requirement (OR = 1.56; p = 0.02) and bone loss substance (OR = 5.45; CI95% = 1.54-20.09) were risk factors of failure for limb salvage treatment. Improvised explosive device traumatic mechanism (OR = 1.56; p = 0.02) and the persistence of surgical site contamination after two debridement procedures (OR = 1.20; p = 0.04) were risk factors of failure for amputation procedures. Two main risk factors of treatment failure are highlighted: those in relation to traumatic mechanisms and general lesional assessment and those in relation to surgical site conditions. There is no over risk of failure in relation to surgical procedure and treatment.

A letter from Alexis Carrel concerning the preantibiotic treatment of war wounds: The Carrel-Dakin solution.

The morbidity and mortality of soldiers injured during the First World War stemmed in large part from infections of battle wounds. Preventing and treating such infections was a major challenge for the medical corps. Alexis Carrel, a French-American surgeon, advocated irrigating open wounds with a hypochlorite solution (the Carrel-Dakin solution) to prevent the growth of bacteria contaminating them. His method of treatment was complicated and time consuming and was not well followed by surgeons who doubted the necessity of such an exacting protocol. In 1917, Carrel wrote a letter to an American colonel overseeing U.S. medical personnel soliciting his support in training American medical personnel in the proper use of the Carrel-Dakin solution. This letter was the stimulus for recalling here the opposition encountered by both Carrel and Joseph Lister, his predecessor in the aseptic-antiseptic treatment of open wounds, and for noting the conflicting views of contemporary surgeons over surgical sepsis.

Ambroise Paré (1510-1590) and His Innovative Work on the Treatment of War Injuries.

The purpose of this study is to summarize the innovations of Ambroise Paré (1510-1590) on the treatment of war wounds and improving amputation technique through ligature in arteries and veins. Ambroise Paré debunked the widely accepted idea that gun powder was poisonous for wounds. He also minimized the use of cautery of wounds by his dressing methods and the application of ligature during amputations. All these innovative rationales revolutionized the practice of war surgery during the Renaissance and paved the way for the introduction of modern surgery. Nevertheless, although his wound dressing innovations became widely accepted, the same did not happen with ligature and amputation; those techniques could become widely applicable if one could somehow control bleeding until the blood vessels had been tied. This became possible much later in the 18th century when Jean Louis Petit invented the first useful and efficient tourniquet.

Treatment of Complex War Wounds of the Lower Leg with Free Flaps and Ilizarov Method - Our Experience

Introduction: Indications for free flaps and Ilizarov method were severe bone fractures with extensive soft tissue defects and segmental bone defects longer than 4cm. The tissue defects of lower leg were classified as Gustillo IIIB and Gustillo IIIC. Microvascular tissue transfer provides closure of extensive defects in one act, better perfusion of the wounded region, make conditions for the reconstruction of deep structures, especially in wounds with complex tissue defects. Ilizarov method is a useful method of bone reconstruction, especially for lower leg. For defects longer than 4 cm, Ilizarov method provides better quality of bone replacement compared with free fibular graft Methodology and Material: We used free flaps and Ilizarov method in treating 27 wounded subjects with vast tissue defects of lower leg at the Clinic of Plastic Surgery and Burns and Clinic of Traumatology and Orthopedic Surgery, with the aim of closing war wounds, covering deep structures and making the preconditions for later reconstruction of bone structures. Three months after the free flap transfer, we performed corticotomy and distraction of the longer (proximal or distal) bone segment of tibia. Results: We analyzed types and time of free flaps applied, duration of the bone transport with Ilizarov apparatus, as well as the quality of reconstructed bone during the five-year follow-up. All of 27 patients that we treated with free flaps and Ilizarov procedure are able to walk independently without orthopedic devices, while the maximal shortening of the leg was 3 cm in 2 (7,4%) patients. Conclusions: The knees and ankles are free for physical therapy in spite of Ilizarov device. In spite of the facts that the surgery is very time-consuming, that there is a need for microsurgical equipment and trained surgical team, in spite of technical complexity of the method and high proportion of unsuccessful unions of bone fragments at the joining site (which surely indicates the need for second procedure and sometimes calls for the modification of Ilizarov procedure), The experience of surgeons with Ilizarov method is of utmost importance because of the long-lasting treatment and frequent check-ups of bone regeneration and sanation of the joining site. The combination of two revolutionary methods in plastic and orthopedic surgery, free flap and Ilizarov methods, is a useful and reliable approach which finds place in the treatment of war wounds with extensive tissue defects of the lower leg.

Plaster

Plaster has been used for centuries as a stiffening agent to treat fractures and other musculoskeletal conditions that require rest, immobilization, or correction of a deformity. Despite modern metallurgy and internal stabilization, plaster casts and splints remain an important means of external stabilization. Casting is a dying art as modern internal and external fixation replace external immobilization. Proper casting technique is paramount. This manuscript outlines the history and chemistry of immobilization materials and techniques as well as the differences among them and the advantages and disadvantages of each. Historical references, peer-reviewed journals, textbooks, and primary sources were reviewed to provide data for this review. The history of immobilization reveals a progressive development and refinement of materials that culminated in Mathijsen's plaster bandage in 1851. In 1798, calcium sulfate (plaster of Paris) was introduced. By 1927, crinoline rolls dipped in plaster treated with binding agents facilitated application. Synthetic casting "tapes" (45% polyurethane resin and 55% fiberglass) were introduced in the 1970s. Splinting techniques are ancient, with development spurred by treatment of war wounds. Plaster relies on soft-tissue contact to maintain rigidity. There are well-known advantages, disadvantages, and complications of plaster management. Casting materials all create an exothermic reaction. Burns are associated with water temperatures of >24°C, more than eight layers (ply), and inadequate ventilation. The maximum water temperature must be lower with fiberglass casts. Plaster was the definitive management for most fractures for over 100 years until it was replaced by modern surgical techniques involving internal fixation in the latter part of the twentieth century. Plaster casts and splints remain an important treatment method for acute and chronic orthopaedic conditions.

Warfare injuries : History, triage, transport and field hospital setup in the armed forces

The treatment of war wounds has been an ancient art, constantly refined and adapted to reflect improvements in warfare strategies, weapons technology, transportation and damage control surgical practices. Throughout history, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons developed systems for rapidly moving the wounded from the battlefield to frontline hospitals. This article reviews the trends in military trauma management including triage, evacuation and field hospital setup in the Armed Forces.

Alexander Fleming, citrated blood and penicillin: paths not pursued and applications delayed

Ninety years ago Alexander Fleming (later to discover penicillin) jointly wrote a description of the use of indirect transfusions of citrated blood at a World War 1 (WW1) base hospital. It was the longest series yet to be published, incorporating what was then a novel procedure for treating war casualties. Returning to civilian life Fleming, a qualified surgeon and bacteriologist, chose a different career path, and not until the wars of the late 1930s were the advances in transfusion in WW1 fully incorporated into the management of trauma and haemorrhage. Like penicillin, the benefits of indirect transfusion were only slowly realised.

SH05 THE CONTRIBUTION OF THEODORE BILLROTH TO THE MANAGEMENT OF WAR WOUNDS IN THE FRANCO‐PRUSSIAN WAR 1870–1

The outcome of war wounds until the late 1800s was dismal, with most significant wounds showing “putrefication and suppuration” prompting surgeons to employ a high rate of amputation. At this time a “spontaneous generation theory” was popular – wound infection being attributed to toxins released by dying tissues. Pasteur's Germ Theory was yet to be published.Billroth spent a summer vacation as a military surgeon during the Franco‐Prussian war (1870–1), a campaign that marked the birth of Germany as a nation. By then Billroth, aged 41, was Professor of Surgery in Vienna, and had already published a book on gunshot wounds in which he had advocated primary closure.He was posted behind the frontline in military hospitals, first in Weissenburg and then in Mannheim. His wartime observations included missile projectiles, prevention of suppuration, removal of bullets, and the impact of a fracture on the risk of infection. On arrival in Mannheim, the incidence of erysipelas had been alarming, but he reduced infection rates by simple hygienic measures, adopting, but modifying, some of Lister's principles of anti‐sepsis. For amputation, he stressed haemostasis, approximation of layers, but allowing open drainage and healing by secondary intention. In October 1870 he had almost 100 patients transferred from Weissenburg to Mannheim so he could study their progress. There was only once case of gangrene.Conclusion: Billroth's involvement in the Franco‐Prussian war resulted in progress in the treatment of war wounds. He changed his original management, established without much experience in Zurich, to advocate cleansing, dilute antiseptics, and open drainage.

Treatment of war wounds: a historical review.

The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.

AL05 OF STRINGS AND SPLINTS AND WARS AND WOUNDS

Robert Hamilton Russell (1860–1933), a Melbourne surgeon of international repute, played a pivotal role in the formation of the College. In 1925 a letter signed by G.A.Syme H.B.Devine and Russell was sent to senior surgeons in Australia and NewZealand suggesting the establishment of a body to improve surgical standards, a proposal first put by Louis Barnett in 1920.Born in Kent with medical training at King’s College, Hamilton Russell was House Surgeon to Lister and profoundly influenced by Lister’s mentoring. Russell emigrated to Melbourne in 1890 and with appointments at the (Royal) Children’s Hospital and the Alfred, developed wide surgical interests including fracture management.At the start of World War I, Hamilton Russell was in England and joined the Australian Voluntary Hospital in France. On returning to Melbourne in 1915 he presented a paper on the treatment of war wounds and in 1916 a paper on fractures included his new method of continuous traction for femoral shaft fracture. At this time the proper management of war wounds and fractures was being vigorously debated.It was not until the Spanish Civil War, three years after Hamilton Russell’s death, that significant advances were made in the management of war injuries. In Barcelona, Joseph Trueta successfully combined the principles of triage, blood transfusion, early surgery, wound excision and plaster immobilisation. In 1939 Trueta escaped to Britain and with the aid of influential colleagues his techniques with some modification were adopted during the 1939–45 conflict and form the basis of war wound management today.

Combat Orthopaedics: A View From the Trenches

Approximately 70% of war wounds involve the musculoskeletal system, and military orthopaedic surgeons have assumed a pivotal role in the frontline treatment of these injuries in Iraq. Providing battlefield orthopaedic care poses special challenges; not only are many wounds unlike those encountered in civilian practice, but patients also must be triaged and treated in an austere and dangerous environment, undergo staged resuscitation and definitive surgery, and endure prolonged medical evacuation, often involving ground, helicopter, and fixed-wing transport across continents. Most orthopaedic wounds in Iraq are caused by exploding ordnance--frequently, improvised explosive devices, or IEDs. Because of advances in care, rapid medical evacuation, and modern body armor, many casualties have survived in Iraq who would not have done so in previous wars. Treatment of war wounds, many of which are devastating in the scope of soft-tissue and bony injury, requires a team approach using hypotensive resuscitation, damage-control orthopaedics, new or rediscovered techniques of hemostatic and intravenous hemorrhage control, vacuum-assisted wound closure, and advanced reconstruction. Current challenges include prevention of infection, a better understanding of heterotopic ossification as a sequela of blast injury, and the need for a comprehensive, joint service database that encompasses the multilevel spectrum of orthopaedic care.

Surgery in the Graeco-Roman era

In the Graeco-Roman era medical treatment characteristically consisted of regimen (diet and a healthy lifestyle), medicaments and surgery – the latter being reserved for those cases in which regimen and medicaments had failed. Evidence of primitive surgery dates back to the Bronze Age, and the Homeric epics describe surgical treatment of war wounds with frequent intervention of the gods. With the arrival of empiric medicine in the 5th century BC, surgery featured prominently in the Hippocratic Corpus by way of excellent contributions on head and orthopaedic surgery in particular. Alexandrian medicine (late 4th century) facilitated surgical development through the knowledge of anatomy and physiology gained from human dissection. Greek medicine brought a much improved standard of surgery to the Roman era (2nd century BC). Physicians were still expected to be proficient in all three modalities of medical practice (above), but surgery was now held in higher regard and specialisation in fields such as eye diseases, obstetrics and women’s diseases, bladder ailments, mouth and throat surgery developed. Military medicine, well organised in Roman times, brought experience in trauma surgery, and procedures penetrating the abdomen and thoracic cavities were no longer uniformly fatal. Veterinary surgery came into being. The first significant surgical textbook after the Hippocratic Corpus was compiled by Celsus in the 1st century AD. From the 3rd century onwards surgery stagnated and the scientific language gradually changed from Greek to Latin. The surgical expertise of the era was carried into the Middle Ages and later predominantly by Islamic physicians.

The treatment of war wounds. By W. W. Keen, M.D., LL.D. Second edition. 8vo. Pp. 276, with 53 illustrations. 1918. Philadelphia and London: W. B. Saunders Co. 8s. 6d. net

The treatment of war wounds. By W. W. Keen, M.D., LL.D. Second edition. 8vo. Pp. 276, with 53 illustrations. 1918. Philadelphia and London: W. B. Saunders Co. 8s. 6d. net

Penicillin in the treatment of war wounds of the chest

Penicillin in the treatment of war wounds of the chest

Pathology and treatment of war wounds. By Sir Almroth E. Wright, M.D., F.R.S., Director of the Inoculation Department and Principal of the Institute of Pathology and Research, St. Mary's Hospital, London; Consultant Physician to the Army in France, 1914–1918. 9¾ × 7⅜ in. Pp. 208 + viii, with 8 illustrations. 1942. London: Williams Heinemann (Medical Books) Ltd. 21s. net

Pathology and treatment of war wounds. By Sir Almroth E. Wright, M.D., F.R.S., Director of the Inoculation Department and Principal of the Institute of Pathology and Research, St. Mary's Hospital, London; Consultant Physician to the Army in France, 1914–1918. 9¾ × 7⅜ in. Pp. 208 + viii, with 8 illustrations. 1942. London: Williams Heinemann (Medical Books) Ltd. 21s. net Get access Pathology and treatment of war wounds. By Sir Almroth E Wright, M.D., F.R.S., Director of the Inoculation Department and Principal of the Institute of Pathology and Research, St. Mary's Hospital, London; Consultant Physician to the Army in France, 1914–1918. 9¾ × 7⅜ in. Pp. 208 + viii, with 8 illustrations. 1942. London: Williams Heinemann (Medical Books) Ltd. 21s. net British Journal of Surgery, Volume 30, Issue 118, October 1942, Page 184, https://doi.org/10.1002/bjs.18003011826 Published: 05 December 2005

Microvascular free flaps and care of war injuries with tissue defects

War wounds caused by modern infantry weapons or explosive devices are very often associated with the defects of soft and bone tissue. According to their structure, tissue defects can be simple or complex. In accordance with war surgical doctrine, at the Clinic for Plastic Surgery and Burns of the Military Medical Academy, free flaps were used in the treatment of 108 patients with large tissue defects. With the aim of closing war wounds, covering deep structures, or making the preconditions for reconstruction of deep structures, free flaps were applied in primary, delayed, or secondary term. The main criteria for using free flaps were general condition of the wounded, extent, location, and structure of tissue defects. The aim was also to point out the advantages and disadvantages of the application of free flaps in the treatment of war wounds. One hundred and eleven microvascular free flaps were applied, both simple and complex, for closing the war wounds with extensive tissue defects. The main criteria for the application of free flaps were: general condition of the wounded, size, localization, and structure of tissue defects. For the extensive defects of the tissue, as well as for severely contaminated wounds latissimus dorsi free flaps were used. For tissue defects of distal parts of the lower extremities, scapular free flaps were preferred. While using free tissue transfer for recompensation of bone defects, free vascularized fibular grafts were applied, and in skin and bone defects complex free osteoseptocutaneous fibular, free osteoseptocutaneous radial forearm, and free skin-bone scapular flaps were used. After free flap transfer 16 (14.4%) revisions were performed, and after 8 unsuccessful revisions another free flaps were utilized in 3 (37.5%) patients, and cross leg flaps in 5 (62.5%) patients. The treatment of war wounds with large tissue defects by the application of free microvascular flaps provided shorter wound-closing period, earlier beginning of physical therapy, as well as the treatment of great number of patients with the extensive tissue defects in the conditions of massive influx of the wounded.

Christine F Salazar, The treatment of war wounds in Graeco-Roman antiquity, Studies in Ancient Medicine, vol. 21, Leiden and Boston, Brill, 2000, pp. xxvii, 299, illus., Nlg 138.83, $78.00 (hardback 90-04011479-3).

Christine F Salazar, The treatment of war wounds in Graeco-Roman antiquity, Studies in Ancient Medicine, vol. 21, Leiden and Boston, Brill, 2000, pp. xxvii, 299, illus., Nlg 138.83, $78.00 (hardback 90-04011479-3). - Volume 46 Issue 1

Pathomorphological and quantitative bacteriological findings in various forms of primary surgery on gunshot wounds of extremities

It is well-known that 'wound excision' is essential in the primary treatment of wounds in war, particularly thorough debridement of the devitalized tissues around the path of a penetrating projectile. Nowadays, the gunshot wounds in peacetime have become prevalent. Instead of the traditional method of 'wound excision' (excision), we used the method of 'incision and drainage' (incision) in the primary surgery of these gunshot wounds of extremities. To determine the treatment effectiveness of these different surgical methods (incision and excision), two groups of dogs were shot in the proximal part of one hind leg with an American M-16 rifle. One group was treated by the method of 'excision'; in the other group 'incision' were performed. No difference in infection rate was noted between the two groups. Similarly, no difference in bacterial count was found between the two groups during the observation period. Also, there was no difference in healing time; the wounds in both groups had healed by 19.2-21.4 days. Microscopic examination revealed a little normal muscle tissue in the necrotic zone of the incision group which might augment the repair process. These results suggest that there are no differences in the effectiveness in preventing infection between the two methods. 'Incision' might be superior to 'excision' for the management of the gunshot wounds of extremities in peacetime, as it involves a simple operation and there are advantages for tissue healing.

The Treatment of War Wounds in Graeco-Roman Antiquity (review)

It is self-evident to anyone who studies the classical world that war was a fact of life, and that wounds were common. It is less obvious that sufficient testimonia survive to allow for an entire book on their treatment. Christine Salazar has gathered a surprising amount of material and crafted it into a splendidly detailed and comprehensive account. The book, which began as a doctoral dissertation under the direction of the distinguished G. E. R. Lloyd, falls essentially into two quite distinct parts. The first, titled "Wounds and Their Treatment," deals with the nitty-gritty of the subject: the sources of information available, types of wounds and their effects, the weapons accounting for wounds, surgical intervention and pharmaceutical applications, medical personnel in Greek and Roman armies, and the criteria for distinguishing professional practitioners from laymen.