The Interface of Cutting-Edge Technology in Mission Sustained Injuries of U.S. Special Operations

Introduction: Traumatic injury is one of the major risks associated with working in the United States Military Special Operations Division. Gunshot wounds, improvised explosive devices, and blunt force trauma are just a few of the methods of injury. Part of their training and operation involves parachute jumps. A special operations paratrooper was transported to an outpatient clinic after a jump in which his parachute dragged him across the Tucson desert where he suffered a stab wound from a branch. The point of entry was his left flank. All vital organs were left undamaged. He was initially treated in an outpatient clinic with irrigation and wound packing. He was then seen at Madigan Army Medical Center with cellulitis and necrotizing soft tissue infections requiring five operations. The original cultures were positive for klebsiella aerogenes and rare enterobacter. Later cultures were positive for fungal infection. Following successful treatment of the infection NPWT was initiated for wound bed preparation.Methods:Serial imaging assessment with a point-of-care, non-contact, near infrared imaging device (SnapshotNIR, Kent Imaging Inc., Calgary, AB, Canada) was performed to assess site specific wound tissue oxygenation and relative perfusion. This was performed in conjunction with serial debridements using the advanced debridement instrument*. Once wound bed was determined to be suitable, a split thickness skin graft was placed. There was 100% take of the skin graft.Results:Over the course of seven debridements the advanced debridement instrument* was used five times. An average 2.2% increase in total wound bed oxygenation was observed following debridements. The patient presented with wound bed StO2 reading of 78%, later peaking at 82%, and dropping to 63% once healed. Total time to heal from initial presentation in the wound care clinic was 13 weeks.Discussion: The benefit of complete serial debridements with an advanced debridement instrument* was supported by NIRS. An increase in oxygen saturation of the total wound bed promotes an optimal healing environment between treatment visits and in preparation for the STSG. Due to the mechanism of action of the advanced debridement instrument*, complete surface debridement is possible without excessively damaging healthy tissue. There is also the possibility of redistribution of healthy keratinocytes from the wound margins into the wound bed which may accelerate healing. All this progress can be tracked by NIRS to determine once a wound is sufficiently oxygenated for graft placement.References: