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An epidemic of surgical wound infections observed at the State Hospital of Sarajevo during June-September 1992 is reported.
A cross-sectional survey of 138 surgical patients with wound infection treated by the Department of Surgery of the State Hospital of Sarajevo was performed in mid-September and again in mid-November 1992. A preliminary evaluation of the bactericidal effectiveness of a new antiseptic preparation called DI-ASEPT also was done.
The frequency of wound infection was 24.4% in September and 19.2% in November. Pseudomonas species was the primary etiologic agent in this epidemic. DI-ASEPT was as effective as povidone-iodine in producing wound asepsis.
Because of limited resources large numbers of casualties, and an extremely adverse environment as a result of war that has affected hygienic conditions at the State Hospital of Sarajevo, a high frequency of contaminated or dirty operations were performed. This was the primary reason for the observed increase in wound infections. After hygienic conditions were restored, the epidemic of wound infections was terminated.
In war, abdominal injuries constitute a significant proportion of the total injuries. These injuries are associated with high mortality and their treatment poses dianostic, surgical, and therapeutic dilemmas. This article presents the epidemiology of abdominal war injuries during the siege of Sarajevo, and briefly describes the surgical techniques and therapeutic practices used in their treatment.
A retrospective medical record review was performed of 273 war casualties with trauma to visceral and vascular structures in the abdomen inflicted during a 7.5 month period in 1992.
Most patients underwent exploratory laparotomy. Six percent had negative laparotomies, and there were no deaths in this group. In 18.3%, injuries were limited to one organ system, while 81.7% sustained combined injuries to multiple-organ systems. The crude mortality rate was 26.0%. Mortality rate excluding deaths within 24 hours of injury was 10.3%. Injuries were caused by metal fragments from artillery shrapnel, mortar and contact mines, or hand grenades. Because of a shortage of colostomy bags, resections of the colon with primary end-to-end anastomoses rather than colostomy were performed in 72% of the cases.
Mortality was highest in those victims with four or more injured organ systems (81.3%) or with major vascular injuries (64.7%). The primary cause of death within the first 24 hours was prolonged hemorrhagic shock.
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