J Trauma
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Burns complicate 5% to 10% of combat associated injuries with infections being the leading cause of mortality. Given the long term complications and rehabilitation needs after initial recovery from the acute burns, these patients are often cared for in dedicated burn units such as the Department of Defense referral burn center at the United States Army Institute of Surgical Research in San Antonio, TX. This review highlights the evidence-based recommendations using military and civilian data to provide the most comprehensive, up-to-date management strategies for burned casualties. Areas of emphasis include antimicrobial prophylaxis, debridement of devitalized tissue, topical antimicrobial therapy, and optimal time to wound coverage.
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Review
Prevention and management of infections associated with combat-related head and neck injuries.
Maxillofacial injuries constitute 16% of all war-related injuries. This review focuses on data available from military and civilian studies to provide evidence-based recommendations for the modification of infections associated with combat-related injuries to the head and neck. The major emphasis of this review is on the study of subsequent infection, perioperative antimicrobial prophylaxis, debridement of devitalized tissue, optimal time to wound closure to achieve a water tight seal, wound irrigation with removal of debris and gross contaminants, fracture fixation, and removal of ocular foreign bodies with intravitreal antibiotics. Further studies are needed in combat-related injuries to the head and neck in military personnel to provide the highest evidence-based medicine recommendations.
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Combat-related injuries to the central nervous system (CNS) are of critical importance because of potential catastrophic outcomes. Although the overall infection rate of combat-related CNS injuries is less than 5%, if an infection develops there is a very high associated morbidity and mortality. This review focuses on the management and prevention of infections related to injuries to the brain or the spinal cord. ⋯ This review provides evidence-based recommendations from military and civilian data to the management of combat-related CNS injuries. Areas of focus include bacteria cultures, antimicrobial therapy, irrigation and debridement, timing of surgical care, and wound coverage. Given these recommendations are not supported by randomized control trials or adequate cohorts studies in a military population, further efforts are needed to answer best treatment strategies.
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Orthopedic injuries suffered by casualties during combat constitute approximately 65% of the total percentage of injuries and are evenly distributed between upper and lower extremities. The high-energy explosive injuries, environmental contamination, varying evacuation procedures, and progressive levels of medical care make managing combat-related injuries challenging. The goals of orthopedic injury management are to prevent infection, promote fracture healing, and restore function. ⋯ Herein, we provide evidence-based recommendations from military and civilian data to the management of combat-related injuries of the extremity. Areas of emphasis include the utility of bacterial cultures, antimicrobial therapy, irrigation fluids and techniques, timing of surgical care, fixation, antibiotic impregnated beads, wound closure, and wound coverage with negative pressure wound therapy. Most of the recommendations are not supported by randomized controlled trials or adequate cohorts studies in a military population and further efforts are needed to answer best treatment strategies.
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During wartime, abdominal and thoracic trauma constitutes approximately 20% of combat-related injuries. Rates of infection vary based upon organ of injury with the highest rates noted for trauma to the colon. ⋯ Areas of focus include antimicrobial therapy, irrigation and debridement, timing of surgical care, and wound closure. Overall, there are limited data available from the modern battlefield regarding the prevention or treatment of these infections and further efforts are needed to answer best treatment strategies.