Penetrating Axilla Injuries and Ceramic Plate Coverage: A Special Operations Case Series.

Introduction: The Department of Defense has continually refined body armor to mitigate battlefield injuries over the last 20 years. Penetrating axilla injuries remain challenging despite adoption of a four-plate ceramic armor system. This study investigates the efficacy of current armor configurations in reducing mortality and morbidity associated with axilla injuries.

Methods: This was a retrospective case series using afteraction reports from a single Special Operations unit. Records (786) from 2001-2018 were screened, yielding 11 meeting inclusion criteria. Data included injuries, body armor type, clinical interventions, and outcomes.

Results: Analysis revealed significant mortality (45%) among casualties sustaining axilla injuries, with 100% mortality for those struck in uncovered side-plate regions under a two-plate system. In contrast, no fatalities occurred when injuries were within protected side-plate regions of a four-plate system. Injury patterns showed consistent thoracic cavity violations, emphasizing the need for robust protection strategies. This study underscores the efficacy of four-plate systems in reducing mortality compared to older configurations, particularly in protecting vital structures like great vessels and the heart. However, limitations in current side-plate coverage suggest potential gaps in protection, especially superiorly. Balancing protection with mobility remains crucial, as highlighted by operational challenges and weight concerns.

Conclusion: Findings support the role of side plates in mitigating axilla injuries but highlight the need for expanded coverage using improved material technologies. Fu-ture research should focus on enhancing ballistic protection without compromising operational agility and refining trauma management protocols for optimal casualty outcomes.