Management of War Limb Injuries in the 21st Century

Background: War trauma includes some of the most complex injury entities that require complex techniques, often in austere settings. After body armor use and advanced resuscitation and evacuation plans, limb injuries and salvage has increased. In this article, we review the recent war injured care, regarding limb injuries.

Methods: Retrospective literature search in PubMed was conducted for articles after 2010, regarding initial limb salvage and advanced reconstruction after evacuation. 43 published articles and manuals were included in the review, so that the latest protocols be interpreted.

Results: Protocols of war surgery and extremity injuries have changed in modern warfare, as high energy weapons often cause severe limb injuries affecting multiple tissues. Of utmost importance is the thorough debridement and staged reconstruction, after optimization of injured tissue condition. In priority series, vascular, bony, nerve and soft tissue injuries have to be addressed. Reconstruction techniques must be adapted to each injury.

Conclusion: As weapons evolve and war conduction changes, medical care must constantly evolve, too, in order to meet the standard of care required to achieve extremity salvage and good functionality.