Correspondence

Care of Battlefield Injuries

N Engl J Med 2004; 351:97-98July 1, 2004

Article

To the Editor:

During Operation Iraqi Freedom, an Iraqi combatant sustained substantial battlefield trauma to his right temporofrontal area, exposing the brain surface. He was brought to a surgical company of the U.S. 1st Marine Expeditionary Force. The operating room was in a tent 20 miles from the front lines. Scalp, bone, and dura were lost as a result of the impact of the projectile. The area was cleaned, and hemostasis was achieved with a combination of thrombin and electrocautery. Closing the wound, making it tight with respect to cerebrospinal fluid until transfer to the next echelon of care (200 miles away), became a problem. A sterile intravenous-fluid bag lining was fashioned to fit the shape of the wound and was sewed with a continuous polypropylene suture to obtain watertight closure (Figure 1Figure 1Closure of a Battlefield Head Wound.). Although the patient was successfully transferred to the fleet hospital, he eventually died from complications of the head injury.

Intravenous-fluid bags have been used previously in the closure of abdominal-wound defects1 but have not been documented as neurosurgical aids. A flexible sterile bag could be an extra tool that surgeons who lack needed materials could use until definitive care can be rendered.

V. Pothula, M.D.
U.S. Naval Hospital, Yokusuka, Japan, FPO AP 96350

Sanjay Gupta, M.D.
Emory University, Atlanta, GA 30322

1 References

1. 1

   Mattox KL. Introduction, background, and further projections of damage control surgery. Surg Clin North Am 1997;77:753-759
   CrossRef | Web of Science | Medline