Microsurgical Management of Blast Injuries. Report of Our Experience on 25 Clinical Cases

Introduction: Blast trauma refers to a specific type of tissues injuries combining the adverse effects of the different mechanisms: the shock waves and the overpressure generated by the blast, tissue laceration caused by the fragmentation of the propelled object, injuries and fractures due to the projection of the victim and finally the burns caused by the heat of the explosion. Being responsible of the only regional center of Hand and Microsurgery in Lebanon, at the American University of Beirut Medical Center, we have been exposed during the last two years to manage 25 patients suffering complex blast injuries to the face and limbs, particularly the hand.

Methodology and Material: They were referred to us from Lebanon and the neighboring countries where the unstable situation “The Arab Spring” created these particular types of injuries. They were 23 males for only two females ranging in age between 23 and 55 years. All patients had complex and composite defects associating skin loss, bones defects and fractures, nerves injuries, tendons dilacerations and joints dislocations particularly when the blast was involving the hand. Other concurrent injuries included degloving injuries, fingers amputations and ischemia were also present in some cases. All patients were treated by debridement of all necrosed and contaminated tissues, as well as primary open reduction, external stabilization or internal fixation of bone fractures. Patients presenting vascular impairment particularly to the lower limb were managed in emergency by the vascular team for vessels reconstruction.

Results: All our patients have benefited from the techniques of free tissue transfer to reconstruct the skeleton bone defect or to restore the skin damage. The reconstructive microsurgery was planned in the early days following the blast injury and after the completion of the required sessions of radical and deep tissues debridement eliminating the contaminated and dead structures. The microsurgical reconstructions were completed before the installation of tissues infections.

Conclusions: Even if usually it is recommended to wait for the tissue healing before considering any type of reconstruction, our experience pushed us to believe that the reconstructive microsurgery is of a great value for these types of injuries. It allows an early restoration of the different lacerated structures and more important, it brings its proper blood turnover offering to these multiple suffering adjacent zones an important healing potential. Also, it plays a great role against the infection process and flips the spontaneous bad prognosis of these injuries to a high level of positive outcome.