• N Ilić, A Petricevic, V Radonić, M Biocić, and M Petricević.
• Department of Surgery, Split University Hospital, Croatia.
• Int Surg. 1997 Jul 1; 82 (3): 316-8.

BackgroundFrom April 1991 till December 1995, Split University Hospital played a major role as a third échelon war hospital during the war in Croatia and Bosnia and Herzegovina. Among 2856 treated battle casualties in general, 70 patients with penetrating thoraco-abdominal war injuries were treated at the Department of Surgery. Explosive wounds were present in 38 (54%), gunshot wounds in 32 (45%) and puncture wounds in four (5.70%) patients.MethodsThe medical data from the evacuation unit, transportation, emergency department, surgical management and follow-up were obtained and analyzed. The principle of treatment of such patients is described, with particular reference to thoracophrenolaparotomy as the most efficient diagnostic-therapeutic surgical approach.ResultsThere were considerably more explosive wounds than gunshot and puncture wounds (ratio 38/32/4). Resource utilization analysis showed a great amount of blood products (average 1.250 ml per patient), rehydrant solutions (average 3.750 ml per patient) and seven days antimicrobial chemoprophylaxis (penicillin, gentamycin, metronidazole) used. Mean time elapsed between injury and definitive surgical repair was seven hours (range, 1 to 48 hours). Recovery on discharge was recorded in 61 (80%) and lethal outcome in nine (13%) patients.ConclusionsThe treatment of respiratory insufficiency and hemorrhagic shock, and prevention of infection are the basis of the management of these injuries. Treatment success depends on emergency first-aid, quick transportation, early diagnosis, resuscitation, surgical therapy and intensive care.

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