Dismounted Complex Blast Injury Management

Abstract

The past 13 years of sustained combat operations in Iraq and Afghanistan have provided a robust and high-volume experience to deployed providers in caring for severe multisystem traumatic injuries as well as managing mass casualty scenarios on a routine basis. With the rise of the use of improvised explosive devices in both combat and civilian arenas, all surgeons must now be prepared to handle these types of injuries. This chapter describes the epidemiology and management of patients injured by blast or explosive mechanisms and outlines key concepts and lessons learned from the recent high-volume military experiences. These injuries typically include a combination of severe blunt and penetrating trauma, with the hallmark dismounted complex blast injury pattern being multiple amputated or mangled extremities, large perineal and/or pelvic wounds, penetrating truncal injuries, and pelvic or spine fractures. A rapid, focused, and team-based approach to the diagnostic workup, resuscitation, and operative intervention is outlined.