Endoscopic evaluation of a complex ballistic injury.

The current conflict in Afghanistan is characterised by significant injuries resulting from the use of Improvised Explosive Devices. Increasing survivability from battlefield injury, escalating musculoskeletal ballistic trauma and the use of blast weaponry combine to produce an injury profile which defines contemporary combat casualty care. Such complex multi-system trauma challenges current wound care rationale. Ballistic injury of the perineum, often associated with proximal femoral injury and significant tissue loss, raises particular management difficulties. These cases demand an individualised, flexible approach due both to the extent of their wounds, logistical issues with positioning and often limited surgical approaches. Routine positioning and approaches around the pelvis may not be available to the surgical team due to presence of external fixators and tenuous skin bridges. The availability of donor skin to cover soft tissue defects is limited and as such, approaches to wounds with minimal additional tissue trauma are of particular use. We describe the benefits of endoscopic techniques and equipment in the evaluation and management of such an injury.