Surgical Strategy and Priorities

The guiding principle is to remove the ordnance by the most expedient means possible. This may require “en-bloc” resection of the tissue around the ordnance with amputation of the affected limb above the ordnance if this is deemed the quickest way to safely remove the ordnance. In general, impaled ordinance should be surgically exposed to a degree that will allow easy removal of the object in the same orientation as it lies in the body. Every effort should be attempted to avoid pushing forward or twisting the UXO during exposure or removal as this may set off triggering mechanism. Great care should be made to avoid banging or contacting the ordnance with hands or surgical instruments. If ordnance is impaled into a limb, the extremity should be stabilized to avoid excessive vibration or movement that could complete the trigger. Simultaneous damage control operations for other injuries should be limited to life and or limb preserving operations. Delay definitive procedures until after the ordnance is safely removed. Once the UXO is removed, it should be gently handed off to an EOD expert or placed in explosive containment device. If the UXO placed in a containment device is in the vicinity of the patient, consider rapidly moving patient to safer location to complete procedure.