Modern War Wounds

being seen in soldiers who survive such catastrophic injuries[6]. The destructive extent of an explosion is dependent on the nature of the device and the proximity of the soldier when it detonates[7]. In contrast to other forms of weapon (ie firearms), explosive devices have the capacity to injure multiple victims simultaneously by a variety of different mechanisms. Detonation of an explosive device results in the instantaneous conversion of explosive material to a high pressure gas. The supersonic expansion of this gas creates a blast wave through space that compresses air at its leading edge forming a high-pressure shock wave, the ‘overpressure’[8]. The negative pressure void created in the wake of the overpressure sucks debris into the air, which is then caught and propelled outwards by the ‘blast wind’ — the mass outward movement of air that follows the overpressure. There are five classes of injury associated with explosive devices, however as victims of blast injuries have multiple wounds involving different bodily systems, injury patterns tend to become less distinct[7,9]. Primary blast injury results from the overpressure as it passes through the body; specifically at air-fluid interfaces, ie the tympanic membrane, lungs and bowel[3], where the rapid compression/ expansion and acceleration/deceleration forces cause significant tissue damage. The extent of primary injury is dependent on the distance of the victim to the explosion epicentre, the size and type of device, and INTRODUCTION The types of war wounds produced by high energy weapons present very different medical and surgical challenges to those previously encountered on the battlefield and to those seen in the civilian setting. Explosion-related injuries create challenges on numerous levels, which will be discussed in this paper based on experience of these wounds at the UK role 4 facility, The Royal Centre for Defence Medicine (RCDM), Queen Elizabeth Hospital, Birmingham University NHS Trust.