As Sergeant Surgeon to King Charles II, Richard Wiseman (1622-1676) was present at many of the battles of the Civil War and he described the war wounds as follows: " Wounds made by gun-shot are the most complicate sort of wounds that can be inflicted: For they are not only solution of continuity, but have joined with them contusion. Attrition, and dilaceration, in a high and vehement kind. To this we may add all sorts of fractures and accidents, as haemorrhagia, inflammation, erysipelas, gangrene, and sphacelus; besides the extraneous bodies which are violently carried into the wound, and multiply indications".
In Colombia we have faced almost a civil war; I would not be able to exactly define in what kind of war we are living now. At the Military Hospital in Bogotá, we have to deal with war wounds caused mainly by: Fragmentation missiles (mortar, grenade shells), Solid missiles (low and high velocity bullets) and antipersonnel mines. With microsurgery we are able to transplant almost any kind of tissue to reconstruct difficult wounds, it is not an easy surgery but is the best way and some times the only way.
CLINICAL CASE 1.
HIGH VELOCITY GUNSHOT WOUND IN THE FOREARM
Preoperative picture: palmar view of the wound.
Preoperative picture: dorsal view of the wound.
Picture of the free flap, in fact there are to flaps (latissimus dorsi and scapular) with one pedicle (subscapular vessels). The radial artery and comitant veins are used as recipient vessels; the latissimus dorsi muscle is used to cover the palm and the scapular skin the dorsum.
Four month postoperative picture, palmar view. (Grafted Latissimus Dorsi muscle flap).
Four month postoperative picture, dorsal view. (Scapular skin flap).
CLINICAL CASE Nº 2.
Picture 1. Left leg amputation and open fracture of right leg. It is very important to save the right leg, in order to rehabilitate the patient.
Picture 2. X Rays of the exposed tibia and fibula fracture.
ANTIPERSONNEL MINE IN THE LEGS
Picture 4. Postoperative picture 4 months after surgery.
CLINICAL CASE Nº 3.
|FRAGMENTATION MISSILE IN THE LOWER EXTREMITY|
CLINICAL CASE Nº 4.
HIGH VELOCITY GUNSHOT WOUND IN THE FACE