War Injury Outcomes Improving

Mar. 26, 2008 — After five years of war in Iraq, there is some relatively good medical news about the casualties over there: more than 90 percent are now surviving injuries that would have been fatal in previous conflicts.

A recent issue of the Journal of Craniofacial Surgery (JCS) contains reports on the surgical and treatment advances behind these gains.

The advances are discussed in several articles by craniofacial surgeons who specialize in head and facial trauma injuries — cases involving noses and lips ripped away in bomb blasts, skulls and jaws shattered by bullets, and skin sheared off by burning debris.

"Trauma that results from war, and trauma we see in hospital wards from car crashes, gang fights, and more, are two different things. But by integrating the knowledge of military and civilian surgeons we are improving outcomes for the casualties of modern war and saving the lives of people who would never have survived years ago," says Dr. Mutaz B. Habal, director of the Tampa Bay Craniofacial Center in Tampa, Fla., and the journal's editor-in-chief.

Civilians May Benefit As Well
According to surgeons who reported their experiences in the journal, changes to treatment guidelines and protocols based on surgical insights, ongoing data collection and analyses have resulted in better treatments for the wounded. In addition, the introduction of civilian trauma experts and weekly video conferences have improved continuity of care for injured soldiers throughout the Military Health System and into the Veterans' Administration system.

"Application of these lessons into training doctrines for standards of practice will ensure optimal outcomes for our patients of today and into the future for soldiers and civilians alike, should the need ever arise," writes JCS contributor Col. W. Bryan Gamble, M.D., of the US Army Medical Corps.

The journal also reports how relatively simple measures to prevent extreme loss of body heat (hypothermia), before wounded soldiers arrive at combat hospitals, have significantly increased survival times. These valuable lessons can be transferred to routine trauma victims in the US to help save more lives.

Better Equipment Often Equals Better Outcome
Wounded soldiers are also transported to hospitals more quickly than ever before, thanks to C-17 Medevacs. "They are really flying ICUs with 12 beds, equipment for resuscitation, IV fluids and more. Just as an ambulance does on the civilian side, the C-17 Medevacs provide damage control," says Dr. Habal, who was an army reserve colonel called to active duty during the first Iraq conflict, Operation Desert Storm.

"We've learned the early operative repair of the orofacial [mouth] region and the reconstruction of the soft tissue position is critical in obtaining optimal aesthetic and functional results. We've also found it is important that the remaining segments of the maxilla and mandible [jaw] be held in an anatomic position through the period of soft tissue and bone reconstruction to limit the magnitude of the deformity," he states.

The results, revealed in photos that accompany the journal articles, are remarkable. They show horribly scarred and misshapen faces transformed into faces that often appear virtually normal.

Making the Best Use of Training Opportunities
Atlanta plastic surgeon Dr. Edwin C. Pound, who travels on volunteer missions each year to third world countries to perform reconstruction and repair surgeries, says war is an unfortunate but good teacher for surgeons.

"You see injuries you would never imagine otherwise and surgeons are placed in the position of having to find ways to do the reconstructions," Dr. Pound says. "The very growth of plastic surgery, in fact, grew out of reconstructive techniques developed in World War II to help soldiers with craniofacial injuries."

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