Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-745bb68f8f-b6zl4 Total loading time: 0 Render date: 2025-01-13T18:50:10.686Z Has data issue: false hasContentIssue false

Chapter 17 - Wound Management in a Field Hospital Environment

from Section 4 - Clinical Considerations

Published online by Cambridge University Press:  09 January 2020

By
Alan Kay
Edited by
Elhanan Bar-On ,
Kobi Peleg  and
Yitshak Kreiss
Elhanan Bar-On
Affiliation:
The Israel Center for Disaster Medicine and Humanitarian Response, Sheba Medical Center, Tel Hashomer, Israel
Kobi Peleg
Affiliation:
National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology and Tel-Aviv University, Disaster Medicine Department
Yitshak Kreiss
Affiliation:
Sheba Medical Center, Tel Hashomer, Israel
Get access

Summary

It is highly likely that a field hospital will need to provide wound care. The very presence of a field hospital indicates that a situation exists where normal healthcare is challenged. It is important that staff understand the situation as it directly impacts on the type of care that should be delivered. The wrong type of care will not just yield suboptimal results for the patients, but will adversely affect workload, impact on resources, and compromise the effectiveness of the facility. Achieving good outcomes in wound care is dependent on ensuring the patient’s general well-being is optimised. The core requirement for wound care is initial wound surgery, which fully evaluates the wound as well as performing debridement and essential immediate interventions. Wounds associated with conflict and disaster should not be primarily closed. Healing is achieved by delayed primary closure or later complex reconstruction.

Keywords

Field hospitalwound caredebridementinitial wound surgeryreconstruction
Type
Chapter
Information
Field Hospitals
A Comprehensive Guide to Preparation and Operation
 , pp. 160 - 179
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Wong, EG, Dominguez, L, Trelles, M, et al. Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster. Surgery 2015: 157(5): 850–6.Google Scholar
Lord, JM, Midwinter, MJ, Chen, YF, et al. The systemic immune response to trauma: an overview of pathophysiology and treatment. The Lancet 2014: 384: 1455–65.Google Scholar
Wilmore, DW. Metabolic response to severe surgical illness: overview. World Journal of Surgery 2000: 24(6): 705–11.Google Scholar
Malchow, RJ, Black, IH. The evolution of pain management in the critically ill trauma patient: emerging concepts from the global war on terrorism. Critical Care Medicine 2008: 36(7 Suppl): S346–57.Google Scholar
Demling, RH. Nutrition, anabolism, and the wound healing process: an overview.World Journal of Plastic Surgery 2009: 9: 65–94.Google Scholar
Hospenthal, DR, Green, AD, Crouch, HK, et al. Infection prevention and control in deployed military medical treatment facilities. The Journal of Trauma and Acute Care Surgery 2011: 71(2 Suppl 2): S290–8.CrossRefGoogle ScholarPubMed
World Health Organization. Antimicrobial Resistance. Online article. https://www.who.int/antimicrobial-resistance/enGoogle Scholar
Penn-Barwell, JG, Murray, CK, Wenke, JC. Early antibiotics and debridement independently reduce infection in an open fracture model. The Journal of Bone and Joint Surgery 2012: 94(1): 107–12.Google Scholar
Dick, EA, Ballard, M, Alwan-Walker, H, et al. Bomb blast imaging: bringing order to chaos. Clinical Radiology 2018: 73(6): 509–16.Google Scholar
Hodgetts, TJ, Mahoney, PF, Kirkman, E. Damage control resuscitation. Journal of the Royal Army Medical Corps 2007: 153(4): 299–300.Google Scholar
Malhotra, AK, Goldberg, S, Graham, J, et al. Open extremity fractures: impact of delay in operative debridement and irrigation. The Journal of Trauma and Acute Care Surgery 2014: 76(5): 1201–7.CrossRefGoogle ScholarPubMed
Enninghorst, N, McDougall, D, Hunt, JJ, Balogh, ZJ. Open tibia fractures: timely debridement leaves injury severity as the only determinant of poor outcome. The Journal of Trauma and Acute Care Surgery 2011: 70(2): 352–6.CrossRefGoogle ScholarPubMed
Prodromidis, AD, Charalambous, CP. The 6-hour rule for surgical debridement of open tibial fractures: a systematic review and meta-analysis of infection and nonunion rates. Journal of Orthopaedic Trauma 2016: 30(7):397–402.Google Scholar
Boulton, AJ, Lewis, CT, Naumann, DN, Midwinter, MJ. Prehospital haemostatic dressings for trauma: a systematic review. Emergency Medicine Journal 2018: 35(7): 449–57.Google Scholar
World Health Organization. Surgical Safety Checklist. Online article. https://www.who.int/patientsafety/safesurgery/checklist/enGoogle Scholar
Arul, GS, Pugh, HE, Mercer, SJ, Midwinter, MJ. Human factors in decision making in major trauma in Camp Bastion, Afghanistan. Annals of the Royal College of Surgeons of England 2015: 97(4): 262–8.Google Scholar
Debakey, ME, Simeone, FA. Battle injuries of the arteries in World War II: an analysis of 2471 cases. Annals of Surgery 1946: 123(4): 534–79.CrossRefGoogle Scholar
Hughes, CW. Arterial repair during the Korean war. Annals of Surgery 1958: 147(7): 555–61.Google Scholar
Rasmussen, TE, Clouse, WD, Jenkins, DH, et al. The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. The Journal of Trauma and Acute Care Surgery 2006: 61(1): 8–12.CrossRefGoogle ScholarPubMed
Bowyer, GW, Cooper, GJ, Rice, P. Small fragment wounds: biophysics and pathophysiology. The Journal of Trauma and Acute Care Surgery 1996: 40(3 Suppl): S159–64.Google Scholar
Sassoon, A, Riehl, J, Rich, A, et al. Muscle viability revisited: are we removing normal muscle? A critical evaluation of dogmatic debridement. Journal of Orthopaedic Trauma 2016: 30(1): 17–21.Google Scholar
Bhandari, M, Jeray, KJ, Petrisor, BA, et al. A trial of wound irrigation in the initial management of open fracture wounds. The New England Journal of Medicine 2015: 373(27): 2629–41.Google Scholar
Hassinger, SM, Harding, G, Wongworawat, MD. High-pressure pulsatile lavage propagates bacteria into soft tissue. Clinical Orthopaedics and Related Research 2005: 439: 27–31.CrossRefGoogle ScholarPubMed
Crowley, DJ, Kanakaris, NK, Giannoudis, PV. Irrigation of the wounds in open fractures. The Journal of Bone and Joint Surgery 2007: 89(5): 580–5.Google ScholarPubMed
Penn-Barwell, JG, Murray, CK, Wenke, JC. Comparison of the antimicrobial effect of chlorhexidine and saline for irrigating a contaminated open fracture model. Journal of Orthopaedic Trauma 2012: 26(12): 728–32.CrossRefGoogle ScholarPubMed
Fries, CA, Ayalew, Y, Penn-Barwell, JG, et al. Prospective randomised controlled trial of nanocrystalline silver dressing versus plain gauze as the initial post-debridement management of military wounds on wound microbiology and healing. Injury 2014: 45(7): 1111–6.CrossRefGoogle ScholarPubMed
Giannou, C, Baldan, M, Molde, A. War surgery: volume II. 2013. ICRC.Google Scholar
Mansoor, J, Ellahi, I, Junaid, Z, Habib, A, Ilyas, U. Clinical evaluation of improvised gauze-based negative pressure wound therapy in military wounds. International Wound Journal 2015: 12(5): 559–63.Google Scholar
Penn-Barwell, JG, Fries, CA, Street, L, Jeffery, S. Use of topical negative pressure in British servicemen with combat wounds. Eplasty 2011: 11: e35.Google ScholarPubMed
Hajibandeh, S, Hajibandeh, S, Idehen, N. Meta-analysis of the effect of tertiary survey on missed injury rate in trauma patients. Injury 2015: 46(12): 2474–82.CrossRefGoogle ScholarPubMed
Serebrakian, AT, Pickrell, BB, Varon, DE, et al. Meta-analysis and systematic review of skin graft donor-site dressings with future guidelines. Plastic and Reconstructive Surgery – Global Open 2018: 6(9): e1928.Google Scholar
Wallenberg, L. Effect of early mobilisation after skin grafting to lower limbs. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 1999: 33(4): 411–3.Google Scholar
Yin, Y, Zhang, R, Li, S, Guo, J, Hou, Z, Zhang, Y. Negative-pressure therapy versus conventional therapy on split-thickness skin graft: a systematic review and meta-analysis. International Journal of Surgery 2018: 50: 43–48.Google Scholar
Hurlow, J, Bowler, PG. Clinical experience with wound biofilm and management: a case series. Ostomy Wound Management 2009: 55(4): 38–49.Google Scholar
D’Alleyrand, JC, Manson, TT, Dancy, L, et al. Is time to flap coverage of open tibial fractures an independent predictor of flap-related complications? Journal of Orthopaedic Trauma 2014: 28 (5): 288–93.Google Scholar
Klem, C, Sniezek, JC, Moore, B, et al. Microvascular reconstructive surgery in Operations Iraqi and Enduring Freedom: the US military experience performing free flaps in a combat zone. The Journal of Trauma and Acute Care Surgery 2013: 75(2 Suppl 2): S228–32.Google Scholar
Khor, WS, Langer, MF, Wong, R, et al. Improving outcomes in tendon repair: a critical look at the evidence for flexor tendon repair and rehabilitation. Plastic and Reconstructive Surgery 2016: 138(6): 1045e–58e.Google Scholar
Trehan, SK, Model, Z, Lee, SK. Nerve repair and nerve grafting. Hand Clinics 2016: 32(2): 119–25.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×