Suicide bombing injuries: the Jerusalem experience of exceptional tissue damage posing a new challenge for the reconstructive surgeon

Suicide bomb injuries vary in form and magnitude. From the onset of the second Palestinian "intifada" in October of 2000 until January of 2004, 577 victims of suicide bombings were admitted to the Hadassah-Hebrew University Medical Center. A single bomber carrying a handbag or belt containing multiple metal objects and explosives carried out most of the attacks. As a result, many of the victims suffered massive tissue destruction in addition to conventional blast injuries. This article describes the management of this trauma-related "syndrome" of combined primary and high-magnitude secondary blast injury. The management of the extensive soft-tissue damage is described and two representative cases presented. Suicide bombing-related injuries in their present form are a true challenge for the reconstructive surgeon.