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Abstract
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INTRODUCTION: During the last 20 years of conflict in the Middle East, improvements in body armor and the use of improvised explosive devices has resulted in an increased incidence of complex craniofacial trauma (CFT). Currently, CFT comprises up to 40% of all casualties. We present new data from the recent conflict in Iraq and Syria during Operation Inherent Resolve.
METHODS: Data was collected for patients treated at Role 1, Role 2, and Role 3 facilities in Iraq and Syria over a one-year period. During this time, a specialized Head & Neck surgical augmentation team was deployed and co-located with the central Role 3 facility. Data included for this cross-sectional study: injury type and mechanism, triage category, initial managing facility and subsequent levels of care, and procedures performed.
RESULTS: Ninety-six patients sustained CFT over the study period. The most common injuries were soft tissue (57%), followed by cranial (44%) and orbital/facial (31%). Associated truncal and/or extremity injuries were seen in forty-six patients (48%). There were marked differences in incidence and pattern of injuries between mechanisms (Figure, all p < 0.05). While IEDs had the highest rate of cranial and truncal injuries, GSW and blunt mechanisms had higher incidences of orbital/facial and neck injuries. Overall, 45% required operative interventions including complex facial reconstruction, craniotomy, and open globe repair. Mortality was 6% with 83% due to associated severe brain injury. Most patients were local nationals (70%) who required discharge or transfer to the local healthcare system.
CONCLUSION: Complex craniofacial trauma is increasingly seen by deployed surgeons, regardless of subspecialty training or location. Deployment of a centrally located Head & Neck team greatly enhances the capabilities for forward deployed management of CFT, with excellent outcomes for both U.S. and local national patients. LEVEL OF EVIDENCE: Level 4, retrospective study.
Language: en |