The scope of wounds encountered in casualties from the global war on terrorism: from the battlefield to the tertiary treatment facility

J Am Acad Orthop Surg. 2006;14(10 Spec No.):S18-23. doi: 10.5435/00124635-200600001-00005.


Injuries seen in Operation Iraqi Freedom range from those that can be managed with nonsurgical wound care only to those requiring amputation or multiple bony and soft-tissue procedures for limb salvage. The contamination and soft-tissue injury caused by exploding ordnance requires an aggressive treatment approach. Severe wounds treated near the battlefield (ie, level II) require meticulous surgical débridement, early fracture stabilization, broad-spectrum antibiotics, and rapid evacuation. Treatment at a level III combat support hospital involves a greater volume of patients and a longer stay because of the presence of Iraqi national patients. In the authors' experience, most US patients requiring surgical treatment were evacuated to a level IV facility (ie, Landstuhl Regional Medical Center) after one or two surgeries. The basic war surgery principles of aggressive resuscitation, early and thorough débridement, short-duration damage-control surgical procedures, and rapid evacuation were critical in our reduction of wound infection rates to below 7% for all admissions.

Publication types

  • Review

MeSH terms

  • Humans
  • Mass Casualty Incidents / statistics & numerical data*
  • Military Medicine / organization & administration*
  • Surgicenters / organization & administration*
  • United States
  • Wounds and Injuries / therapy*