Soft tissue and wound management of blast injuries

Abstract

The management of blast-related soft tissue wounds requires a comprehensive surgical approach that acknowledges extensive zones of injury and the likelihood of massive contamination. The experiences of military surgeons during the last decade of war have significantly enhanced current understandings of the optimal means of mitigating infectious complications, the timing of soft tissue coverage attempts, and the reconstructive options available for definitive wound management. Early administration of antibiotics in the setting of soft tissue wounds and associated open fractures is the single most important aspect of open fracture care. Both civilian and military reports have elucidated the incidence of invasive fungal infection in the setting of high-energy injuries with significant wound burdens, and novel treatment protocols have emerged. The type of reconstruction is predicated upon the zone of injury and location of the soft tissue defect. Multiple reports of military cohorts have suggested the equivalency of various techniques and types of soft tissue coverage. Longer-term follow-up will inform future perspectives on the durability of these surgical approaches.

Fig. 1

Case example of a 49-year-old gentleman who sustained a mangled left upper extremity with soft tissue loss. Initial injury (a), 2 weeks (b) and 3 weeks (c) after Integra bilayer matrix application, and 6 months after split-thickness skin graft application (d)

Fig. 2

Type of upper extremity flap reconstruction based upon location of injury (reproduced from [••])

Fig. 3

Type of lower extremity flap reconstruction based upon location of injury (reproduced from [••])