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. 2008 Jul 21:8:e34.

Methods of advanced wound management for care of combined traumatic and chemical warfare injuries

John S Graham  1 , Travis W Gerlach, Thomas P Logan, James P Bonar, Richard J Fugo, Robyn B Lee, Matthew A Coatsworth
Affiliations

Methods of advanced wound management for care of combined traumatic and chemical warfare injuries

John S Graham et al. Eplasty. .

Abstract

Objective: Chemical warfare agents are potential threats to military personnel and civilians. The potential for associated traumatic injuries is significant. Damage control surgery could expose medical personnel to agents contaminating the wounds. The objectives of this study were to demonstrate efficacy of surgical decontamination and assess exposure risk to attending personnel.

Methods: Weanling pigs were randomly assigned to 2 of 4 debridement tools (scalpel, Bovie knife, Fugo Blade, and Versajet Hydrosurgery System). Penetrating traumatic wounds were created over the shoulder and thigh and then exposed to liquid sulfur mustard (HD) for 60 minutes. Excisional debridement of the injuries was performed while vapors over each site were collected. Gas chromatography was used to measure HD in samples of collected vapors. Unbound HD was quantified in presurgical wound swabs, excised tissues, and peripheral tissue biopsies following solvent extraction.

Results: Excisional debridement produced agent-free wound beds (surgical decontamination). A significant amount of HD vapor was detected above the surgical fields with each tool. Apart from the Versajet producing significantly lower levels of HD detected over thigh wounds compared with those treated using the scalpel, there were no differences in the amount of agent detected among the tools. All measured levels significantly exceeded established safety limits. Vesicating levels of unbound HD were extracted from excised tissue. There was no measured lateral spreading of HD beyond the surgical margins.

Conclusions: There is significant occupational exposure risk to HD during surgical procedures designed to stabilize agent-contaminated wounds. If appropriate protective measures are taken, surgical decontamination is both effective and safe.

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Figures

Figure 1a
Figure 1a
Preparation (preexposure template marking).
Figure 1b
Figure 1b
Scalpel excision with gas capture funnel over field.
Figure 1c
Figure 1c
Bovie® excision with gas capture funnel over field.
Figure 1d
Figure 1d
Fugo Blade® excision with gas capture funnel over field.
Figure 1e
Figure 1e
Versajet™excision with gas capture funnel over field.
Figure 2
Figure 2
Log (TWA) by location and tool. A significant interaction of wound location (shoulder, thigh) and tool (no. 15 scalpel blade, Bovie® knife, Fugo Blade®, and Versajet™) was observed. This interaction appeared to be due to the scalpel group. When the scalpel group was removed from the analysis, the interaction was not significant, and no other significant differences were observed between tools and locations. A separate analysis for each location was performed to compare tools. There were no significant differences observed among the tools for the shoulder wounds. A significant difference between the scalpel and Versajet™ was observed for the thigh, where the amount of HD detected in the collected fumes was significantly lower for the Versajet™ than for the scalpel blade. TWA = 8-hour-time-weighted average where 3 ng/L of liquid sulfur mustard = 1 TWA. The dashed red line represents the Department of Army's worker population limit 8-hour TWA of 0.0004 mg/m. BOVIE = Bovie® Electrosurgical Knife, FUGO = Fugo Blade® M100 Anterior Capsulotomy Unit, SCALPEL = no. 15 scalpel blade, VERSA = Versajet™ Hydrosurgery System.
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