INTRODUCTION

Surgeons from civilian practice may have no previous experience of managing war wounds. Preparation for war surgery involves an understanding of wounds. Texts concerning wound ballistics based on laboratory work are intended to provide a basis for understanding wound management. The most valuable information derived from these studies is that small missiles may cause large and serious wounds. Misunderstandings arise because these studies focus on bullets when, in armed conflict, the majority of wounds are actually caused by fragments from bombs, shells or mines. When undertaking war surgery, the surgeon rarely knows the weapon nor does he find a uniform pattern of wounding.

The surgical task presented by any wound depends on the wound severity i.e. the degree of tissue damage and also the structure(s) that may have been injured. Recognition of this demands a clinical classification of wounds that is based on the features of the wound and not on the weaponry or the presumed velocity of the missile.

The Red Cross wound classification is a system whereby certain features of a wound are scored: the size of the skin wound(s); whether there is a cavity, fracture or vital structure injured; the presence or absence of metallic foreign bodies. A numerical value is given to each feature as shown overleaf. The scores can later be graded according to severity and typed according to the structures injured.

This scoring system is intended for quick and easy use in the field.

Skin wounds Cavity Fracture Vital structure(s) injured Metallic fragments (X ray)

Fig 1A

Fig 1B

A patient with a gunshot wound of the head. The entry is on the forehead. The radiographs (figure 1b) show the small entry and exit wounds of the cranium and a linear fracture. This is a serious wound because of the structure injured. (E 1, X 1, C 0, F 1, V 1, M 0; Grade 1, Type VF).

Fig 2A

Fig 2B

Fragment injury of the right leg. Both entry and exit wounds are large. This is a serious wound because of the amount of tissue damage. The patient subsequently had above knee amputation. (E 25, ? X 5, C 1, F 2, V 0, M 0; Grade 3, Type F).