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War Surgery, Field Manual
Hans Husum with Swee Chai Ang and Erik Fosse

Third World Network
ISBN 983-9747-14-12 (hb)
ISBN 983-9747-12-6 (pb)
764 pages
21x27 cm


US$140.00 for First World countries
US$50.00 for Third World countries
Prices are inclusive of postage costs by airmail

War surgery, Field Manual takes a unique approach to the subject of trauma and war surgery. Unlike the usual literature written for well-equipped, conventional armies and Western-style hospitals---thus of limited value to doctors, and community health workers facing less than ideal conditions in Third World countries---this manual adopts the standpoint of poor and vulnerable communities and staff, caught in wars they did not ask for.

In this ground-breaking work, the authors have set a standard reference for care under difficult conditions, with the lack of medical facilities and proper staff. They promote a concept of forward life support and surgery close to the front line, which draws on the resources and knowledge of the local community, which improvises with local equipment and materials, and also includes a complete guide to post-operative, high-energy nutrition based on local foodstuffs and food-processing traditions. The authors have distilled in this well-illustrated textbook the knowledge gained after 15 years of experience with post-Vietnam generation of weapons during surgery in the Middle East, Afghanistan and South East Asia.

". . . . a wealth of information on the organization of war medical service and on approaches to setting up forward clinics . . . . an indispensable tool for surgeons and medical assistants who find themselves in circumstances of war . . . . no other manual in existence covers this information with such depth and clarity."
David Werner, the author of Where There is No Doctor.

"We have used the procedures recommended in War Surgery, Field Manual in building a network of mobile forward clinics. Since 1989 our field clinics have provided limb and life-saving surgery to more than 5,500 war casualties from the combat grounds in Central and Eastern Afghanistan. With its simple terminology and clarifying illustrations, the book has proved to be very useful in training of graduate as well as non-graduate medical staff."
Dr. Assadullah Reha MD, Medical Director
Mujahed Emergency Medical Centre, Jalalabad, Afghanistan.

". . . . This is something that is not easily obtained from literature, and this book will be an important contribution to the field . . . . It will help establish a standard of care for military and non-military health care providers . . . ."
Prof. John A. Weigelt MD, Vice-Chairman
Department of Surgery, University of Minnesota, USA.

"War Surgery, Field Manual was extremely well done and represented a nice summary of the problems. Certainly, it will be of great interest to any military medical personnel."
Prof. F. William Blaisdell MD, Chairman
Department of Surgery, University of California, USA.


Foreword-why this book
How to use the book

Section1: The war medical organization

1. The war medical network

Examples from recent regional wars
Training of medical staff

2. The forward clinic (FC)

Organization of forward basic life support (BLS)
The BLS team
Management routines
Organization of the forward clinic (FC)
Standard medical and technical equipment
Light and heavy BLS kits
The one-man mobile FC
Consumption of medical materials
Cleaning and maintenance of instructments
How to improvise

Section2: Basics of war surgery

3. Physics of the weapon

Weapon theory
The wound track
Blast injuries
Mine injuries
Modern arms and ammunition

4. Physiology of the injury

The tissue reponse to injury
The body response to injury

5. The clinical examination

Access vital functions-pain and anxiety
Access vital functions-airways and breathing
Access vital functions-circulation
Examine the regional injuries
Abdominal and pelvic injury
Head and neck injury
Spinal injury
Fracture and joint injury
Nerve injury

6. Triage-sorting casulties

The principles of triage
Triage in mass casulties

7. BLS: Basic life support and basic life-saving surgery

Fundamentals of basic life-saving surgery
Free airway
Support the breathing, Chest drainage
Manage circulatory shock
Manage pain and fear
Early carbohydrate nutrition
Procedures of basic life-saving surgery
Prevent heat loss-start early rewarming
Emergency thoracotomy and aortic clamping
Emergency laparotomy
Liver emergencies
Injury to the spleen
Duodenal and stomach emergencies
Pancreatic emergencies
Kidney emergencies
Limb emergencies
Multi-injred burn cases

8. Surgical technique

Non-traumatic technique
Choice of incisions
Dissection and retraction
Control of bleeding
Surgery on bone
Sufures and surgical knots

9. Fasciotomy, debridement and drainage

Plan your surgery
Fasciotomy - when and how
The debridement in detail
Methods for drainage

Section 3:  General procedures

10. Injuries to arteries and veins

Types of vascular injury
Primary amputation, ligature or reconstruction?
Complications of vascular surgery

11. Fractures

Types of fractures
Healing of fractures
Soft tissue flaps
Joint protection
Battlefied management
The Trueta plaster method
External fixation
Delayed healing and infested fractures

12. Joint injuries

Evaluation of joint function
The soft tissue problem
Fracture through joints
Infected joints

13. Tendon injuries

Primary management
Secondary reconstruction

14. Nerve injuries

Diagnosis and exploration
Secondary nerve repair

15. Amputations

Evaluation of extensive limb injuries
Types of emergency amputations
Amputation theory-the elective amputation
Early prosthesis training

16. Wound closure

Monitor the wounds
Closure by spontaneous granulation
Delayed primary suture (DPS)
Skin grafts
Skin flaps

17. Injuries to children and old people

Basic life support and surgery in children
Basic life support and surgery in old people

18. Emergency blood transfusion

Reasons for blood transfusion
Emergency blood tranfusion
Complications of blood transfusion

19. Hypothermia and hyperthermia

Management of hypothermia
Management of hyperthermia

20. Disease interfering with surgery

Types of anemia
Malabsorption and vitamin deficiencies
Typhoid fever

Section 4:  Specific injuries

21. Injury to the head and neck

Surgical anatomy
Preparations for surgery
Scalp injury
Open skull injury
Control bleeding inside the skull
Skull hematoma after closed skull injury
Complications of skull surgery
Management of neck injury

22. Injury to the spine

Surgical anatomy
Types of spinal injury
Preparations for surgery
Open spinal injury
Spinal fractures
Complications of injury and surgery
Rehabilitation after spinal injury

23. Injury to the face

Surgical anatomy
Preparations for surgery
Soft tissue injury
Open fractures
Midface fractures
Upperface fractures

24. Injury to the eye

Surgical anatomy. The examination
Preparations for surgery
Eyelid injury
Penetrating eye injury
Complications of injury and surgery

25. Injury to the chest

Surgical anatomy
Types of wartime chest injury
Preparations for surgery
Chest wall injury
Exploration of the chest-standard thoracotomy
Cardiac injury
Emergency thoracotomy
Complications of injury and surgery

26. Abdominal injuries in general

Priorities for surgery
Preparations for surgery
Abdominal wall injury
The midline incision. The exploration
Methods of control bleeding
Emergency laparotomy

27. Injury to the intestine

Surgical anatomy
The general procedure in missile injury
Two-step management in emergencies
Injury to the small intestine
Injury to the colon
Injury to the rectum
Reconstruction after enterostomy

28. Injury to the liver and biliary tract

Surgical anatomy
Liver injury
Complications of liver injury and surgery
Injury to the biliary tract

29. Injury to the stomach and duodenum

Surgical anatomy
Stomach injury
Injury to the duodenum and promimal jejunum
Emergency procedures
Complications of injury and surgery

30. Injury to the spleen

Surgical anatomy
Removal of the speen-splenectomy
Complications of injury and surgery

31. Injury to the pancreas

Surgical anatomy
Pancreatic injury
Complications of injury and surgery

32. Injury to the kidneys

Surgical anatomy
Injury to the kidney
Injury to the ureter
Complications of injury and surgery

33. Injury to the urinary bladder and urethra

Surgical anatomy
Types of injury
Injury to the bladder
Injury to the urethra
Complications of injury and surgery

34. Injury to the male organs
35. Injury to the female organs

Surgical anatomy and physiology
Anesthesia to the pregnant woman
Injury to the pregnant woman
Injury to the non-pregnant woman
Complications of injury and surgery

36. Complications of abdominal surgery

Post-operative monitoring
The management of common complications

37. Pelvic injury

Surgical anatomy
Preparations for surgery
Penetrating pelvic injury
Hip joint injury
Exploration of the main arteries
Pelvic fractures
Complications of injury and surgery

38. Upper limb injury

Preparations for surgery
Shoulder and arm injury
Surgical anatomy
Exploration of shoulder injury
Shoulder fractures
Extensive shoulder injury
Exploration of arm injury
Open arm fractures
Elbow injury Surgical anatomy
Exploration of shoulder injury
Elbow fractures
Extensive elbow injury
Forearm and hand injury Surgical anatomy
Exploration of forearm and hand injury
Fractures of the forearm and hand
Extensive hand injury
Amputations at the forearm and hand
Complications of injury and surgery

39. Lower limb injury  

Preparations for surgery
Thigh injury
Surgical anatomy
Fasciotomy and exploration
Fracture management
Crush injuries
Thigh amputations
Injury to the distal thigh and knee Surgical anatomy
Preparations for surgery
Exploration for missile injury
Open joint fractures
Amputations at the knee joint
Lower leg injury
Surgical anatomy
Preparations for surgery
Exploration and fasciotomy
Fracture management
Types of amputation
Complications of limb injury and surgery

40. Burns

Physiology of burn injury
Examination and classification of burns
Fluid therapy
Triage of wartime burns
Basic life support
Manangement of the burn wound
High voltage electrical burns
Chemical burns
Complications of burns

Section 5: Treatment after surgery

41. Monitoring and complications after surgery

Monitor the war wound
Monitor vital functions
Respiratory failure
Ciculatory failure
Renal failure
Coagulation system complications
Multi-organ failure

42. Nutrition after injury and surgery

Why enteral feeding-why homemade diets
Metabolic response to injury and surgery
Malnutrition complications surgery
Planning post-operative nutrition
Monitor the nutrition
Enteral feeding
Common foodstuffs and their nutrient value
Food processing and the viscoty problem
Home-made diets for enteral feeding
Common high-energy diets for oral feeding
Field standards of volume and weight

43. Exercises and physical rehabilitation

Draw up a rehabilitation program
Respiratory support and exercises
Basic training therapy
Training after limb injury
Ambulation and walking aids
Rehabilitation after head and spinal injury
Rehabilitation of multi-injury patients

44. Microbiology and infections

What is bacteria
What is infection
Guidelines for treatment
Septic shock
Bacteria important in surgery
Common infections and common antibiotics
Resistance to antibiotics
Disinfection and sterilization

Section 6 : Field anesthesia

45. Wartime anesthesia complications

Airway obstruction
Circulatory collapse
Sympathetic hyperactivity
Side effects of general anesthetics
Side effects of local anesthetics

46. Local anesthesia

Infiltration anesthesia
Intercostal nerve block, Pleural analgesia
Brachial plexus nerve block
Axillary nerve block
Nerve block of the hand
Femoral nerve block
Nerve block of the foot
Regional intravenous anesthesia

47. Spinal anesthesia

The anesthetics
The procedure

48. Intermittent Ketamine anesthesia


1. Management quality control
2. Blood-grouping, cross-matching, and blood-banking
3. Microscopic examination of bacteria. The gram-stain procedure
4. Books recommended for further studies