War injuries to the extremities

Aim: The authors present their own experience in the treatment of war injuries to the extremities during the war in Croatia and in Bosnia and Herzegovina. Method: From November 1991 until April 1994, 186 patients with war injuries to the extremities were treated. Treatment began with first aid offered at the battlefield, followed by transport of patients to war hospitals, and transfer of the most severe cases to the rear hospital (Split University Hospital). Results: Isolated injuries to the extremities were present in 155 patients (83%), 38% of them with injuries to soft tissues of the extremities and 62% with both soft-tissue injuries and bone fractures. Associated minor injuries to the other parts of the body were present in 31 patients (17%). Amputation of the extremity was performed on 22.5% of the patients. All fractures were treated by external fixation, whereas soft-tissue lesions were managed by debridement and excision of the damaged tissue, with compulsory antibiotic and antitetanic therapy. The rates of mortality and infection were 0.5 and 6.4%, respectively. Conclusion: Our experience emphasizes the importance of field hospitals in timely and adequate treatment of war wounds to the extremities. Treatment of the wound by a trained professional within 2 hours after wounding saved many lives and extremities. The patients were only rarely referred to the rear hospital.