In more extensive injuries with significant tissue loss, repair will depend upon the location and extent of the injury and the experience of the surgeon. If the lower third of the ureter is injured, it may be reimplanted into the dome of the bladder through a muscular tunnel. The kidney can be mobilized, if necessary, to provide some additional length. Repairs should be done transversely or on a bias to maintain the diameter of the lumen since strictures may otherwise result. Drainage of all urinary repairs is required.
Closed suction is preferred.
Colon Injuries to the colon frequently result from penetrating abdominal injuries. The basic rule is that combat injuries of the colon ,hould not be closed. The reason for such a didactic approach is that these patients have an unprepared colon, usually have associated injuries, and it is unlikely that the operating surgeon will be able to follow the patient through the postoperative period. These particular lessons have been learned and relearned at great expense in previous conflicts. An option that is consistent with these guidelines is exteriorization of certain colon repairs.