Wounds and Injuries of the Soft Tissues

To maximize the preservation of life and minimize the attendant morbidity of battle wounds, the surgeon attempts to localize or isolate the deleterious effects of injury and to optimize healing. This objective is best accomplished by removal of all foreign material and detached or severely disrupted muscle from the wound, by the establishment of open drainage of the wound’s recesses, and by maintaining adequate capillary perfusion of the injured tissues. Early institution of systemic antibiotic therapy plays more than an ancillary role in the management of these contaminated war wounds. If these management objectives are achieved, the risk of further local tissue destruction and systemic invasion by pathogenic micro-organisms is reduced to a minimum. The emphasis of this chapter is on the management of damaged muscle. Surgical management of other soft tissue and bone injuries is dealt with in other chapters. Two separate mechanisms are responsible for the injury caused by the passage of missiles through tissues. As the projectile punches through muscle, it destroys the tissue in its direct path by crushing it. Temporary cavitation forces, which present about one millisecond after passage of the projectile, stretch the tissues adjacent to the permanent missile track and result in additional injury or destruction. .