Clinical guidelines for complex extremity wound management: update and consensus using a mixed-method approach
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background
Extremity trauma is a common and significant injury sustained by military and civilian casualties of war. Civilian management has evolved, adopting a multidisciplinary orthoplastics approach. Accurate and timely management of open fractures and complex war wounds is required to minimise complications and optimise outcomes. The Lower Limb Debridement for Operations Working Group is part of the UK Defence Medical Services (DMS) and aimed to provide updated guidelines to support the deployed surgeons, given the modern nature of conflict.
Method
The Working Group formed a panel of military consultants (attendings) in Trauma & Orthopaedics and Plastics & Reconstructive Surgery. Literature was systematically reviewed for new evidence. A modified Delphi Technique was adopted, circulating an initial survey to the working group gaining their opinion on current guidance. Responses were used to formulate updated guidance on combat wound management by the steering group chairs. A consensus meeting with consultants (attendings) was then used to agree the final guidance.
Results
8 previous recommendations were removed and 21 new recommendations were formed providing updated guidelines. Recommendations relate to timing, location, and technique of wound excision including irrigation and requirements for wound closure.
Conclusions
Civilian and military combat casualties require well prepared surgeons and evidence-based guidance to save life and limb. These recommendations represent a consensus, utilising up to date literature and expert opinion of both Orthopaedic and Plastic Surgeons. In large scale combat operations, NHS surgeons working in the UK may be required to treat large numbers of patients repatriated from conflict. These guidelines may form a useful part of their preparation.
Extremity trauma is a common and significant injury sustained by military and civilian casualties of war. Civilian management has evolved, adopting a multidisciplinary orthoplastics approach. Accurate and timely management of open fractures and complex war wounds is required to minimise complications and optimise outcomes. The Lower Limb Debridement for Operations Working Group is part of the UK Defence Medical Services (DMS) and aimed to provide updated guidelines to support the deployed surgeons, given the modern nature of conflict.
Method
The Working Group formed a panel of military consultants (attendings) in Trauma & Orthopaedics and Plastics & Reconstructive Surgery. Literature was systematically reviewed for new evidence. A modified Delphi Technique was adopted, circulating an initial survey to the working group gaining their opinion on current guidance. Responses were used to formulate updated guidance on combat wound management by the steering group chairs. A consensus meeting with consultants (attendings) was then used to agree the final guidance.
Results
8 previous recommendations were removed and 21 new recommendations were formed providing updated guidelines. Recommendations relate to timing, location, and technique of wound excision including irrigation and requirements for wound closure.
Conclusions
Civilian and military combat casualties require well prepared surgeons and evidence-based guidance to save life and limb. These recommendations represent a consensus, utilising up to date literature and expert opinion of both Orthopaedic and Plastic Surgeons. In large scale combat operations, NHS surgeons working in the UK may be required to treat large numbers of patients repatriated from conflict. These guidelines may form a useful part of their preparation.
Date Acceptance
2025-12-02
Citation
BJS Open
ISSN
2474-9842
Publisher
Oxford University Press
Journal / Book Title
BJS Open
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted