Complex soft tissue injuries associated with portable charger detonation: four case reports from the war in Ukraine

Abstract

This article describes the characteristics and management of injuries associated with ricochet effects due to portable charger detonation. We present a case series of four military personnel who sustained complex soft tissue injuries when portable chargers detonated after being struck by projectiles during combat. All patients were treated by an advanced surgical team at the Military Medical Clinical Center of the Northern Region in Kharkiv, Ukraine, over a 9-month period in 2023. Patient history, physical examination findings, laboratory studies, radiographic imaging, treatment approaches, and early outcomes were examined. All patients were male, with a mean age of 33±0.3 years. Complex soft tissue injury patterns arose when a projectile (such as a bullet or shrapnel) struck the charger, causing ricochet effects while damaging the battery housing and triggering detonation. The anatomical region of injury corresponded to the charger’s placement in the patients’ pockets, namely the thigh or buttock. Characteristic findings included local chemical burns of the skin and subcutaneous tissue, with surrounding ecchymosis. Surgical teams identified three zones of damage associated with this injury pattern: (1) a central zone with the most pronounced burn related changes, covering the smallest area of the three zones; (2) an intermediate zone of soft tissue damage from thermochemical reactions extending beyond the charger’s profile; and (3) an outer zone of ecchymosis. Risks associated with carrying portable chargers during combat have not been well documented. These findings may inform injury prevention strategies for military personnel.

INTRODUCTION

Tissue damage is the morphological substrate of trauma. In the context of traumatic injury, this damage can have various manifestations, including penetrating or blunt mechanisms, deceleration forces, crush injuries, contusions, dislocations, fractures, burns, and frostbite. Combat related trauma introduces additional mechanisms, such as chemical, biological, radiological, and other weapon-related factors. Many combat injuries reflect combined mechanisms associated with multiple simultaneous effects from a single weapon type [1–4]. A wound is a form of trauma defined as mechanical tissue damage with a breach of the integrity of the external tissues [1–4]. For instance, a gunshot wound causes direct injury to tissues and organs, violates the overlying skin or mucous membranes, and is characterized by a zone of primary necrosis, a surrounding zone of secondary tissue damage, and microbial contamination that elevates the risk of infectious complications [5,6].

Multiple elements influence the mechanism of ballistic wounds, including damage from a shock wave of highly compressed air forming ahead of the projectile, permanent cavitation due to the direct impact, and temporary cavitation caused by tissue shearing as kinetic energy is transferred along the trajectory [7,8]. In ballistic injuries, the extent of tissue damage is determined by the projectile’s velocity, mass, cross sectional area, resistance encountered on impact, propensity to deform or fragment, and amount of kinetic energy transmitted to surrounding tissues [3,5,9]. Ballistic wounds can be further classified as blind or tangential (when the projectile does not penetrate the damaged tissues), penetrating (when it enters and remains within the tissues), through-and-through (when it passes completely through and exits the body), or ricochet injuries [1]. A bullet or other projectile destabilized by an intervening object can create atypical entry wounds or ricochet effects [1]. A ricochet—defined as the rebound or deflection of an object at an angle from the surface it strikes—may occur externally or internally [1,9].

A USB power bank is a device designed to recharge devices, such as mobile phones, when conventional electrical sources are unavailable. Most portable chargers feature a metal casing and lithium ion battery. Mechanical damage to a battery cell can cause an internal short circuit, prompting the cells within the power bank to self ignite and begin overheating. When the temperature reaches 70 to 90 °C, the ion-conducting protective layer on the anode begins to decompose; because these reactions with the electrolyte are exothermic, both temperature and internal pressure continue to rise. At 180 to 200 °C, the cathode material—typically a transition metal oxide with lithium embedded in its crystal structure—undergoes disproportionation, releasing oxygen. This potentiates self-ignition along with an even sharper jump in temperature. The electrolyte thermally decomposes between 200 and 300 °C, releasing additional heat. Graphite then reacts with any remaining electrolyte, and by 660 °C, the aluminum current collector melts. Temperatures rarely exceed 900 °C, as all reactive components have by then decomposed [4,5,8,10]. Military personnel frequently rely on portable chargers in austere field conditions where standard charging options are unavailable. Advanced surgical teams treating war wounded servicemembers in Ukraine recently managed a series of complex soft tissue injuries resulting from portable charger detonation. The aim of this case series is to describe the characteristics and management of injuries associated with ricochet effects from these detonations.

CASE REPORTS

Here, we present a series of four military personnel who sustained complex soft tissue injuries from ricochet effects associated with the detonation of portable battery chargers. These patients were treated by an advanced surgical team at the Military Medical Clinical Center of the Northern Region, Kharkiv, Ukraine, over a 9 month period in 2023. Patient data were recorded in both paper and electronic formats. Variables including patient history, physical examination findings, laboratory studies, injury characteristics, radiographic imaging, treatment approaches, and early outcomes were examined. Information on the portable charger manufacturers and technical specifications was unavailable, as the damaged power bank was discarded at the location of injury in all cases.

Demographic and injury patterns

All patients in this series were healthy men with no significant medical or surgical history (Table 1). The mean patient age was 33±0.3 years. The anatomical region of injury corresponded to the location of the portable charger in each patient’s pocket—either the posterior thigh or buttock. Patient 1, a 33-year-old man, sustained a 1% total body surface area (TBSA) deep partial-thickness contact chemical burn with associated ecchymosis of the posterior left thigh (Fig. 1). Patient 2, a 28-year-old man, experienced a 0.3% TBSA superficial partial-thickness contact chemical burn with ecchymosis of the right buttock (Fig. 2). Patient 3, a 36 year old man, sustained a 1% TBSA superficial partial-thickness contact chemical burn with ecchymosis of the posterior right thigh (Fig. 3). Patient 4, a 33-year-old man, experienced a 1% TBSA mixed superficial and deep partial-thickness contact chemical burn with ecchymosis of the posterior right thigh (Fig. 4).

Table 1.

Injury characteristics

Patient no.	Sex	Age (yr)	Anatomical region of injury	Laterality	Burn depth	TBSA (%)
1	Male	33	Posterior thigh	Left	Deep partial thickness	1.0
2	Male	28	Buttock	Right	Superficial partial thickness	0.3
3	Male	36	Posterior thigh	Right	Superficial partial thickness	1.0
4	Male	33	Posterior thigh	Right	Mixed superficial and deep partial thickness	1.0

TBSA, total body surface area.

Fig. 1.

Patient 1 (33 years old), 4 days after injury.

Fig. 2.

Patient 2 (28 years old), 5 hours after injury.

Fig. 3.

Patient 3 (36 years old), 7 hours after injury.

Fig. 4.

Patient 4 (33 years old), 8 hours after injury.

Laboratory examinations and radiographs

Laboratory testing revealed mild leukocytosis, with leukocyte counts up to 11.0×10⁹/L (reference range, 4×10⁹/L–11×10⁹/L). General urinalysis was unremarkable. Chest radiographs showed no abnormalities, and limb radiographs demonstrated no orthopedic injuries. Imaging revealed no foreign bodies in the soft tissues.

Treatment and early outcomes

All four patients underwent staged necrosectomy and debridement of nonviable tissue, followed by intensive local wound care to promote re epithelialization. None required skin grafts or local flap reconstruction. Each patient received medical therapy including antibiotics (cefuroxime 500 mg twice daily for 7 days) and anti-inflammatory medications. Local wound care consisted of daily changes of nonadherent aseptic dressings and hyperbaric oxygen therapy sessions (20 minutes every other day, for a total of five sessions). Each patient then underwent a 3-week rehabilitation period: week 1 involved non–weight bearing active and passive movements, week 2 progressed to 50% loading, and week 3 was characterized by a return to full functional activity. The mean treatment duration was 21.5±3.41 days, primarily due to intradermal edema and pain upon resumption of activity. All patients returned to active duty with their units. No complications or unanticipated events occurred during or after treatment.

Characteristics of injuries associated with portable charger detonation

Several common features were identified among the patients in this case series. Characteristic manifestations include a local chemical burn of the skin and subcutaneous tissue, with surrounding ecchymosis. When a projectile—such as a bullet or shrapnel—strikes a portable charger, a thermochemical reaction within the device produces a contact burn in adjacent tissues. Due to kinetic energy transfer from the wounding shell, the adjacent soft tissues sustain a contusion that extends beyond the burn area. Tissue injury is demarcated on the skin, with injury margins clearly outlining the profile of the charger. Surgical teams identified three zones of damage associated with this injury pattern: (1) a central zone with the most pronounced burn related changes, covering the smallest area of the three zones; (2) an intermediate zone of soft tissue damage from thermochemical reactions extending beyond the charger’s profile; and (3) an outer zone of ecchymosis (Fig. 5).

Fig. 5.

Zones of soft tissue damage after ricochet-type injury from portable charger detonation following projectile impact. (A) Top view. (B) Side view. 1, the central zone containing the most pronounced changes associated with projectile impact; 2, the intermediate zone of secondary thermochemical injury from charger detonation; 3, the outer zone of surrounding ecchymosis; 4, unaffected soft tissues.

Ethics statement

All patients provided consent for treatment. Because these data were collected during active wartime as de identified clinical records of routine care, authorizations included the patient’s informed consent for treatment and approval for data publication provided by the Medical Forces of the Armed Forces of Ukraine.

DISCUSSION

This case series describes four Ukrainian military servicemembers who sustained combined thermal and mechanical soft tissue injuries secondary to the detonation of portable chargers carried in their pockets. This injury mechanism has not been thoroughly characterized in the literature. Given the widespread reliance on portable chargers by military personnel in austere environments without access to standard electrical power sources, the appearance of this pathology is unsurprising. Case reports and reviews have documented injuries from portable charger malfunctions, including but not limited to detonation; however, to our knowledge, no studies have examined the impact of charger related detonations in military populations [10–13]. Military personnel may be particularly susceptible to these injuries due to the elevated risk of mechanical disruption of chargers by combat activities and projectiles.

In this case series, multiple common characteristics emerged across patients and injury patterns. Unlike the simple burns from portable chargers previously described, the complex mechanism of charger detonation following projectile impact combines several forms of tissue injury [10–13]. When a projectile fragment or shrapnel from munitions—such as rockets, mortars, or firearms—embeds within the charger, penetrating soft tissue injury is reduced; however, the impact precipitates a thermochemical reaction, which causes a contact burn. The ricochet effect of a projectile striking a portable charger may also alter the projectile’s trajectory. In the patients in this case series, the projectile fragment entered and remained within the portable charger. The fragment’s kinetic energy, combined with local effects of the thermochemical reaction on the adjacent soft tissues, generated contact chemical burns and surrounding ecchymoses of varying severity. Surgical teams defined three concentric zones of damage. A central zone, representing the most severe tissue damage, was observed where the projectile struck the portable charging device. An intermediate zone, arising due to the heating of the charger’s elements, extended beyond the profile of the device. Finally, an outer zone of ecchymosis was present due to the transfer of kinetic energy by the shell. In the hours immediately following injury, the charger’s contour was sharply demarcated on the skin by the transferred kinetic energy from the deflected projectile.

All patients in this series were injured by both the projectile’s kinetic energy and the thermochemical reaction triggered by portable charger detonation. Although thermochemical activation clearly poses risks, the charger’s physical presence may have also provided mechanical protection against projectile penetration. Reports on injury patterns associated with portable charger use in combat are absent from the literature; thus, to our knowledge, no empirical data are available describing the balance between risks and protective aspects. This topic merits further study, particularly since chargers are commonly carried in areas unprotected by body armor, such as the buttock or thigh.

This case series had several limitations. Specifically, the small sample size (n=4) limits the generalizability and robustness of our conclusions and observations. Second, this report is drawn from a single conflict in Ukraine, in which portable charger usage patterns may differ from those in other theaters. Nonetheless, we present a structured account of this injury phenomenon among Ukrainian military personnel, which may inform injury prevention strategies for service members operating in austere combat environments.

The cases presented here demonstrate that current patterns of portable charger use pose a risk to the safety of military personnel operating in combat roles. To reduce the risk of injury from charger malfunctions following projectile impact, several measures are recommended. First, military personnel should be advised against carrying portable chargers in their pockets or on their person during combat operations. Second, military leadership and logistics teams should establish alternative options such as secure, central charging stations to recharge essential devices in austere settings. Surgical teams have a responsibility to their frontline colleagues to report emerging injury patterns, thus enabling early recognition and prevention of potential safety hazards. Further research on similar incidents in other conflict zones may help develop context-specific strategies for reducing risks associated with portable charger use in low resource settings with limited power source options.