Blast Injuries Caused by Explosive Materials, 31 Cases, Comparison with Gunshot Injuries Series

Introduction: An explosive is a material capable of producing an explosion by its own energy. Explosives produce heat and gas. An explosion or blast follows sudden release of energy8 from a chemical, gaseous, mechanical or even nuclear means dissipated by a blast wave, propelling fragments and surrounding material, and causing heat formation. The gas is the primary mechanism by which the explosive produces its effects.

Methodology and Material: 31 Patients injured with blast injuries caused to fireworks, bombs or dynamite had been operated, consisted by 29 hand-upper limb and 2 lower limb injuries. The patients had been urgently operated depending the involved anatomical elements to the injury by amputations, vascularized flaps, revascularizations, replantation, stabilization by external osteosynthesis, nerve grafts, skin grafts.

Results: 22 patients underwent to a partial or total limb amputations, 1 to a finger revascularization, 6 treated by pedicled or free flaps, 2 of them combined with ilizarof and bone or skin grafts. All reconstructed limbs recovered and the impaired limbs were substituted with adequate prosthesis.

Conclusions: Contrary to traditional teaching, a simplistic view of gunshot wounds, based on either bullet velocity, or on energy transfer, may lead to mistakes in management. The surgeon must learn to assess the pattern of injury as a whole, and only then come to a decision about how aggressively to treat a particular wound. Infection, vascular injury and nerve injury are common and may ultimately be the determinants of the outcome, rather than the fracture alone.