To the Editor: During Operation Iraqi Freedom, an Iraqi combatantsustained substantial battlefield trauma to his right temporofrontalarea, exposing the brain surface. He was brought to a surgicalcompany of the U.S. 1st Marine Expeditionary Force. The operatingroom was in a tent 20 miles from the front lines. Scalp, bone,and dura were lost as a result of the impact of the projectile.The area was cleaned, and hemostasis was achieved with a combinationof thrombin and electrocautery. Closing the wound, making ittight with respect to cerebrospinal fluid until transfer tothe next echelon of care (200 miles away), became a problem.A sterile intravenous-fluid bag lining was fashioned to fitthe shape of the wound and was sewed with a continuous polypropylenesuture to obtain watertight closure (Figure 1). Although thepatient was successfully transferred to the fleet hospital,he eventually died from complications of the head injury.
Panel A shows a right temporofrontal defect closed with material from a sterile intravenous-fluid bag. Panel B is a schematic diagram of the defect.
Intravenous-fluid bags have been used previously in the closureof abdominal-wound defects1 but have not been documented asneurosurgical aids. A flexible sterile bag could be an extratool that surgeons who lack needed materials could use untildefinitive care can be rendered.
V. Pothula, M.D. U.S. Naval Hospital Yokusuka, Japan FPO AP 96350
Sanjay Gupta, M.D. Emory University Atlanta, GA 30322
References
Mattox KL. Introduction, background, and further projections of damage control surgery. Surg Clin North Am 1997;77:753-759. [CrossRef][Web of Science][Medline]
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