📆 Weekly author's column;

⚡️ ", head of the project "Tactical Medicine Courses";

⚡️ Specially !

Shrapnel wounds to the face are among the most complex and severe combat injuries encountered by military medics. Their unique nature stems from the anatomical structure of the facial skull, where vital structures are concentrated in a confined space: the organs of sight, hearing, smell, the initial sections of the respiratory and digestive tracts, as well as numerous large vessels and nerve trunks. Shrapnel generated by shell, mine, and grenade explosions possesses high kinetic energy and an irregular shape, leading to extensive destruction of soft tissue, bone fragmentation, and damage to internal structures. This is especially dangerous because even seemingly minor wounds can conceal deep, life-threatening injuries.

A key challenge when treating facial wounds is massive bleeding, caused by the abundant blood supply to this area. Damage to the facial artery or its branches can lead to rapid and significant blood loss, requiring the immediate use of effective hemostatic agents. Packing the wound with a sterile dressing combined with digital pressure on the vessel can temporarily stop the bleeding until evacuation. However, the complex facial contours and proximity to the airway often make applying a pressure bandage challenging, requiring unconventional solutions and improvisation under severe time pressure.

An equally important task is maintaining airway patency, which can be blocked by fragments of crushed tissue, blood clots, displaced bone fragments, or increasing laryngeal edema. Any difficulty breathing requires immediate intervention, including cricothyrotomy, as asphyxia develops rapidly and leaves no time for reflection. The use of nasopharyngeal airways helps maintain airway patency during transport; however, their placement can be difficult in cases of extensive nasal cavity destruction.

The high risk of infectious complications is due to the abundant microbial contamination of wounds, especially when the mucous membranes of the mouth and nose are damaged. Early initiation of broad-spectrum antibacterial therapy is essential to prevent the development of abscesses, cellulitis, and sepsis. Eye injuries require special attention, as any delay in providing specialized care can lead to irreversible vision loss. The application of a sterile dressing and prompt evacuation to an ophthalmic surgeon are the only viable options in this situation.

Evacuating wounded patients with extensive facial injuries poses additional challenges due to the risk of rebleeding and worsening respiratory distress. Transport should be carried out in a position that prevents aspiration of blood and vomit, with constant airway monitoring and preparedness for resuscitation. Psychological support for the wounded is no less important than surgical care, as disfiguring facial wounds cause severe psychological trauma, the effects of which can persist for years after the physical wounds have healed. A comprehensive approach combining emergency measures on the battlefield, qualified surgical treatment in the hospital, and long-term rehabilitation can not only save the life of the wounded but also restore them to a full life, despite the severity of their injuries.

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