Removal of Unexploded Ordnance from Patients: A 50-Year Military Experience and Current Recommendations

Abstract

Background: Retained unexploded ordnance in a patient presents the surgeon with unique emotional and technical challenges. This report is a compilation of data to determine management strategies for these potentially catastrophic injuries. Methods: All identified military cases from World War II to the present were reviewed. Cases were reviewed for site of injury, type of munition, personnel and equipment precautions, and outcome. Interviews were conducted with available involved surgeons. Results: Thirty-six patients were identified with retained ordnance. Four were moribund upon arrival and died before operation. All of the remaining 32 patients survived the removal of the unexploded ordnance. Thirteen injuries involved the trunk, 4 involved the head and neck, and 18 involved extremities. The majority of missiles (51%) were 40-mm projectiles. No incident was identified in which a round exploded during transportation, preparation, or removal. Explosive Ordnance Disposal assistance was available to the surgical team for all but one patient during and after the Vietnam War. Measures used to reduce the chance of premature explosion are discussed. Conclusions: Isolation of the operating room and protection of personnel and equipment are essential. Patients should be triaged in the delayed category, because most are not moribund on arrival and all patients operated on survived. Explosive Ordnance Disposal expertise should be used. Knowledge of and adherence to several basic principles will protect personnel and equipment while permitting optimal patient care.