Understanding progressive tissue loss and wound burden in combat casualties: lessons learnt for future operational capability

Abstract

Understanding tissue loss following injury is important due to its prevalence among the war-wounded and the impact it has on subsequent treatment and rehabilitation. Progressive tissue loss is a type of tissue loss that has complicated extremity injury in recent conflicts. It has resulted in more proximal residual limb lengths and has influenced rehabilitation. Quantifying wound burden in combat casualties remains a challenge due to poor quality of data sets that lack the capacity for detailed analysis. The aims of this article are to outline the current hurdles in attempting to quantify wound burden in combat casualties and to propose simple interventions to improve data capture for future analysis.

Keywords: Plastic & reconstructive surgery; Trauma management; WOUND MANAGEMENT.

Figure 1. Example image with scale bar and appropriate lighting. Image includes the joint above and below the wound.

Figure 2. ImageJ software was used to analyse the figure and estimate the wound surface area. Wound per cent is calculated by estimating the wound surface area as the percentage of the limb surface area visible on photography.

Figure 3. Percentage of the components of the wound bed. The surface area tool in ImageJ was used to assess the total area of the wound image occupied by different tissues.

Figure 4. (A) Outline of current pitfalls of image documentation in defence patients. (B) How a streamlined electronic patient record could facilitate wound data collection and MDT discussion. MDT, multidisciplinary team. R3, Role 3; R4, Role 4.