Surgical treatment of 1,211 patients at the Vinkovci General Hospital, Vinkovci, Croatia, during the 1991-1992 Serbian offensive in east Slavonia.

The work of the Vinkovci General Hospital in the 1991-1992 war in Croatia is described. Because the hospital was only 400 m from the front line and the enemy shelled it incessantly (it is estimated that the hospital was hit by 5,000-7,000 heavy artillery shells), the surgical services worked in the cellar. Between May 1, 1991, and July 1, 1992, 1,211 patients were admitted and subsequently operated on. Of these, 51 died (4.3%), 12 of them on admission. Bullet wounds were found in 41 patients (3%), and 1,092 (90%) were wounded by shell explosions, 53 (4%) by mine explosions, and 25 (2%) contracted burns. Most of the patients were adults, but 50 children, half of them with serious wounds, were also treated. Almost two-thirds of our patients were soldiers or policemen, and one-third were civilians. Four of the patients were prisoners of war. The proportions of heavy and light wounds among the soldiers and civilians were almost exactly 50%. At almost all sites, the ratio of penetrating to nonpenetrating injuries was rather high. With regard to wounds to the head, 38% of the wounds were penetrating. We operated on 181 patients with thorax injuries, of which 80 were penetrating. A high proportion of the injuries were on the arms and legs, the latter accounting for more than 45% of all wounds. A relatively high proportion of traumatic amputations, as well as blast contusions and fractures, were attributable to the fact that most of the wounds were caused by explosions (90%). Their seriousness required a total of 70 surgical amputations on upper extremities and 156 amputations on lower extremities. There were many more vessel injuries on lower extremities than on upper extremities. In our work, we applied the war medical doctrine used through-out the country, which essentially adhered to the NATO doctrine. The differences with NATO doctrine stemmed from the fact that Croatian military medicine emerged from civilian prewar medicine and worked fully integrated with it throughout the war. Yet, our results correspond to the results and experiences of other authors belonging to developed military medical services.