Organization of evacuation of the wounded in wartime: the impact of patient routing on treatment outcomes and infection risks

Abstract

Combat-related limb injuries in modern warfare are characterised by high-energy tissue destruction, extensive soft-tissue defects, and a high risk of infectious complications. Evidence from previous military conflicts in Iraq and Afghanistan, as well as civilian trauma centres, indicates that optimal management of such patients requires not only appropriate surgical tactics but also timely routing to specialised orthoplastic centres. Early radical debridement and definitive wound coverage within the orthoplastic «fix and flap» concept and BOAST standards are associated with reduced infection rates, fewer reoperations, and avoidance of delayed amputations. Despite the central role of evacuation pathways, quantitative data on how different evacuation models influence clinical outcomes in contemporary war conditions remain limited.