CLOSURE

War wounds are contaminated and frequently result from high velocity injuries. Unless they occur from mechanisms other than battle injury, war wounds should not be treated with primary wound closure in the deployed setting. Though no hard rules exist for the closure of battle injuries, wartime experience demonstrates four broad categories of wound outcome:

1. Healing by secondary intention
2. Delayed primary closure with or without drain placement
3. Split thickness skin graft over local soft tissue
4. Tissue transfer with subsequent split thickness skin graft

Which of these four closure strategies is best suited for any given wartime soft tissue injury is left to the discretion of the surgical team.