The Management of Blast Injury of the Hands related to Warfare Explosive Devices

Research Paper Title

Blast injury of the hand related to warfare explosive devices: experience from the French Military Health Service.

Background

The objective was to report on the experience of the French Army Health Service in the management of blast injury of the hands related to warfare explosive devices.

Methods

A retrospective study was conducted in the Percy Military Hospital (role 4 medical treatment facility) among French soldiers who presented with a combat-related blast injury of the hand between 2002 and 2018.

The functional result was assessed by the disabilities of the arm, shoulder and hand (DASH) and the Orthotics and Prosthetics User Survey (OPUS, upper extremity functional status) scores. Proximal amputations (PAs) and distal amputations (DAs) were distinguished for the analysis.

Results

Fifteen patients with a mean age of 31±8 years were included.

They totalised 20 blasted hands. There were 16 traumatic amputations: 8 in each of the PA and DA groups. Twelve patients had additional injuries, four of which were polytraumatic.

Skin closure time and flap use were higher in the DA group. Only one thumb reconstruction was performed.

At a mean follow-up of 6.5±4 years, the number of amputees wearing a prosthesis was higher in the PA group. The mean DASH and OPUS scores were 35.5%±24.0% and 64.0%±19.0%, respectively, with no difference between the two groups.

Conclusions

The severity of hand blasts related to warfare explosive devices requires the systematic application of damage control surgery.

PAs are frequent and secondary reconstruction options are limited.

The functional result is poor and similar between proximal and distal amputees.

Reference

Pfister, G., Murison, J.C., Grosset, A., Duhoux, A., Lapeyre, E., Bauer, B. & Mathieu, L. (2020) Blast injury of the hand related to warfare explosive devices: experience from the French Military Health Service. BMJ Military Health. pii: jramc-2019-001326. doi: 10.1136/jramc-2019-001326. [Epub ahead of print].

Advertisements

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.