Introduction

As a veteran of the U.S. Army, and having a grandfather who was a U.S. Army combat medic, I have always had an interest in combat wound care. Wound care has evolved immensely throughout the years in the military arena. The treatments used as far back as the fifth century B.C. were inconceivable. Examples are keeping wounds dry, wound irrigation with water and wine, burning oil into infected wounds, and topicals such as egg yolks, rose oil, and turpentine applied to the wound bed.¹ Odor was controlled with bags of lavender at the soldier’s bedside.¹ Today, the military is using the latest technologies, such as digital imaging and telemedicine. This allows them to send combat wound images from the battlefield or to prepare the hospital site for their injured soldier.

Common Combat Wound Types

Combat wounds are much more complex because of higher contamination, mostly resulting from the environment where the wound occurred. Faster wound healing time or surgical closure is indicated because of painful dressing changes and risk of infection.² The most common combat wounds include:

1. Blast wounds – landmines, grenades, IEDs (improvised explosive devices), suicide bombings. Amputation rates are high.
2. Gunshot and shrapnel wounds
3. Head injuries and fractured bones¹

Challenges in Managing Combat Wounds

Dressings

The challenge and complexity of combat wounds are the large wound size and the heavy amount of drainage. The following represent the current standard of care when working with a combat wound.²

1. Impregnated polyhexamethylene biguanide gauze dressings
2. Silver dressings – antimicrobial properties
3. Negative pressure wound therapy – less frequent dressing changes, and controls high amounts of exudate
4. Moisture sensors – allows dressing decisions without disturbing the dressing

Debridement in Combat Wounds

Combat wounds must be debrided aggressively, both bony and soft tissues. Debridement must be performed as soon as possible and under magnification using surgical operating loupes. High-pressure water jets and surgical instruments are used in combination to clean bone and soft tissues.²

Nutritional Challenges

Soldiers who have been deployed for a longer duration are more likely to be malnourished at the time of traumatic injury. Enteral feeding is implemented for soldiers with complex injuries.²

Conclusion

Combat wound care has improved immensely throughout the years. Utilizing a combination of technologies may be necessary in developing the most effective treatment plan. Using a holistic approach in managing combat wounds has been shown to be most beneficial. The quality of life of a soldier is paramount.

References

1. Taylor C, Jeffery S. Management of military wounds in the modern era. Wounds Int. 2009;5(4):51–8. http://www.woundsinternational.com/media/issues/280/files/content_8827…. Accessed July 10, 2018.

2. Jeffery SLA. The management of combat wounds: the British military experience. Adv Wound Care. 2016;5(10):464–73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067872/. Accessed July 10, 2018.

About the Author

Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter. She is the first LPN to be inducted as an Association for the Advancement of Wound Care (AAWC) speaker.