Skip to main content

Early Microsurgical Management of Blast Injuries

  • Chapter
  • First Online:
Reconstructing the War Injured Patient

Abstract

Over the past years, plastic surgeons in the Middle East and Arab region are dealing with an increasing number of war blast injuries, particularly to the upper extremity and hand, in the acute, subacute, and chronic phases, referred from war zone countries like Iraq and Syria, where the resources to treat such complex injuries are scarce. This chapter is a comprehensive review of the basic principles of management of blast injuries to the hand and upper extremity based on the available literature merged with the author’s personal experience. The state-of-art of treatment of blast injuries, starting from ammunition physics, wound ballistics and ending with the principles of surgical management are discussed. The indications of reconstructive microsurgery are particularly addressed as it offers a useful tool for reconstructing the anatomy and restoring function.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Granberry WM. Gunshot wounds of the hand. Hand. 1973;5:220–5.

    Article  CAS  PubMed  Google Scholar 

  2. Fackler ML. Gunshot wound review. Ann Emerg Med. 1996;228:194–203.

    Article  Google Scholar 

  3. Peters C. Wound ballistics of unstable projectiles. Part II. Temporary cavity formation and tissue damage. J Trauma. 1996;40:16–21.

    Article  Google Scholar 

  4. Swan KG. Gunshot wounds: pathophysiology and management. Chicago: Year Book Medical Publishers; 1989.

    Google Scholar 

  5. Dugas RD. Civilian gunshot wounds. Orthopaedics. 1985;8:1121–5.

    CAS  Google Scholar 

  6. McCorkell SJ, Harley JD, Morishima MS, Cummings DK. Indications for angiography in extremity trauma. AJR Am J Roentgenol. 1985;145:1245–7.

    Article  CAS  PubMed  Google Scholar 

  7. Ordog GJ, Wasserberger J, Kram H, Bishop M, Shoemaker W. Extremity gunshot wounds: part one. Identification and treatment of patients at high risk of vascular injury. J Trauma. 1994;36:358–68.

    Article  CAS  PubMed  Google Scholar 

  8. Ordog GJ, Balasubramanium S, Shoemaker W. Civilian gunshot wounds: outpatient management. J Trauma. 1994;36:106–11.

    Article  CAS  PubMed  Google Scholar 

  9. Gomez GA, Kreis Jr DJ, Ratner L, Hernandez A, Russell E, Dove DB, et al. Suspected vascular trauma of the extremities: the role of arteriography in proximity injuries. J Trauma. 1986;26:1005–8.

    Article  CAS  PubMed  Google Scholar 

  10. Sirinek KR, Levine BA, Gaskill 3rd HV, Root HD. Reassessment of the role of routine operative exploration in vascular trauma. J Trauma. 1981;21:339–44.

    Article  CAS  PubMed  Google Scholar 

  11. Smith RF, Hageman JH, Elliot JP, Hageman JH, Szilagyi DE, Xavier AO. Acute penetrating arterial injuries of the neck and limbs. Arch Surg. 1974;109:198–205.

    Article  CAS  PubMed  Google Scholar 

  12. Friedrich PL. Die aseptische Versorgung frischer Wunden. Langenbecks Archiv fur Klinische Chirurgie. 1898;57:288–310.

    Google Scholar 

  13. Le Maitre R. Primary suture of war wounds. Lyon Chir. 1918;15:65.

    Google Scholar 

  14. Fackler ML, Bellamy RF, Malinowski JA. The wound profile: illustration of the missile-tissue interaction. J Trauma. 1988;28(Suppl):21–9.

    Article  Google Scholar 

  15. Snyder III WH, Perry MO. Vascular injuries of the extremities. In: Rutherford RB, editor. Vascular surgery. Philadelphia: WB Saunders; 1989. p. 613–22.

    Google Scholar 

  16. Stein J. Gunshot wounds to the upper extremity: evaluation and management of vascular injuries. Orthop Clin North Am. 1995;26:29–36.

    CAS  PubMed  Google Scholar 

  17. Omer Jr GE. Nerve injuries associated with gunshot wounds of the extremities. In: Operative nerve repair and reconstruction. JB Lippincott: Philadelphia; 1991. p. 655–62.

    Google Scholar 

  18. Kasprzak H. Morphological studies of gunshot wounds of the peripheral nerves in rabbits. Pol J Neurol Neurosurg. 1984;18:567–82.

    CAS  Google Scholar 

  19. Dubuisson AKD. Indications for peripheral nerve and brachial plexus surgery. Neurol Clin. 1992;10:935–51.

    CAS  PubMed  Google Scholar 

  20. Kline DG. Timing for exploration of nerve lesions and evaluation of the neuroma-in-continuity. Clin Orthop Relat Res. 1982;(163):42–49.

    Google Scholar 

  21. Bakhach J, Katrana F, Panconi B, Baudet J, Guimberteau JC. Temporary ectopic digital implantation: a clinical series of eight digits. J Hand Surg Eur Vol. 2009;34:227–34.

    Article  CAS  PubMed  Google Scholar 

  22. Hull JB, Cooper GJ. Pattern and mechanism of traumatic amputation by explosive blast. J Trauma. 1996;40(Suppl 3):198–205.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joseph Bakhach M.D., Ph.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Bakhach, J., Abou Ghanem, O.M. (2017). Early Microsurgical Management of Blast Injuries. In: Abu-Sittah, G., Hoballah, J., Bakhach, J. (eds) Reconstructing the War Injured Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-56887-4_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56887-4_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56885-0

  • Online ISBN: 978-3-319-56887-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics