Stanec Z, Skrbić S, Dzepina I, Hulina D, Ivrlac R, Unusić J, Montani D, Prpić I
Department of Surgery, School of Medicine, University of Zagreb, Croatia.
Scand J Plast Reconstr Surg Hand Surg. 1994 Mar;28(1):39-44. doi: 10.3109/02844319409015993.
We present our experience in the treatment of war wounds in 174 patients treated in the Institute of Plastic and Reconstructive Surgery, Department of Surgery, Clinical Hospital Center in Zagreb. The wounds were divided into four categories depending on the type of injury and the extension of the soft tissue defect which showed the differences in primary excision and reconstruction of wounds. Patients were placed in one of two groups depending on their primary treatment and time of definitive reconstruction. Group A comprised 79 patients who were initially treated by plastic surgeons and whose reconstructive procedure was done within five days. Group B comprised 95 patients who were initially treated in a field hospital and referred later to the plastic surgery unit for definitive reconstruction more than five days after the injury. Sixty-nine (87%) of the patients in group A had only one or two debridements before definitive closure and stayed in hospital 20 days or less. In group B, 59 (62%) of the patients required three or more debridements before definitive closure and remained in hospital more than 21 days (p < 0.001). Proper primary treatment and early reconstruction result in significantly shorter duration of hospital stay and lead to more effective rehabilitation and recovery of the patients. A knowledge in terminal ballistics is important in the understanding of the pathophysiology of war wounds.
我们介绍了在萨格勒布临床医院中心外科整形与重建外科研究所治疗的174例战争伤员的经验。根据损伤类型和软组织缺损范围，将伤口分为四类，这显示了伤口一期切除和重建的差异。根据患者的初始治疗方法和确定性重建时间，将患者分为两组。A组包括79例患者，他们最初由整形外科医生治疗，重建手术在5天内完成。B组包括95例患者，他们最初在野战医院接受治疗，受伤5天以上后转诊至整形外科进行确定性重建。A组69例（87%）患者在确定性闭合前仅进行了一两次清创，住院时间为20天或更短。B组中，59例（62%）患者在确定性闭合前需要进行三次或更多次清创，住院时间超过21天（p<0.001）。适当的初始治疗和早期重建可显著缩短住院时间，并使患者获得更有效的康复和恢复。终点弹道学知识对于理解战争伤口的病理生理学很重要。
