Combat Soft Tissue Injuries

Purpose of Review: The soft tissue injuries encountered in combat are generally orders of magnitude more dramatic that those seen in civilian practice. The goal of this chapter is to help shorten the learning curve to care for the extensive soft tissue wounds of war by reviewing the limited research available on the subject and sharing lessons learned from the battlefield. Recent Findings: Data from recent conflicts in Iraq, Afghanistan, and Syria demonstrate that the soft tissue injuries sustained in a warzone are unique compared to the types of injuries seen in civilian practice. These injuries have high infection rates, result in extensive tissue loss, and require special strategies to optimize outcomes. Summary: Devastating soft tissue injuries in combat are often accompanied by multiple life-threatening injuries and one must have a systematic approach to evaluation and treatment. War wounds are highly contaminated. Early antibiotics, thorough exploration, serial debridement, and irrigation are the mainstays of therapy. While plans for wound closure must start with the first operation, all combat wounds should initially be left open.