Some Soldiers Can Undergo Surgery For Facial Fractures In War Zones

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Main Category: Cosmetic Medicine / Plastic Surgery
Also Included In: Bones / Orthopedics
Article Date: 20 Nov 2007 - 0:00 PDT

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Some soldiers can undergo surgery for facial fracture without being taken out of war zones, as long as they meet certain criteria, says an article in Archives of Facial Plastic Surgery (JAMA/Archives), November/December issue.

Approximately 61% of all US patients wounded during Operation Iraqi Freedom experienced a head and neck injury, the authors explained. "Prior to May 2005, most American military personnel with facial fractures were air evacuated from the Iraqi theater for definitive treatment of their facial fractures. Concerns about sterility, infection with Acinetobacter baumannii (a bacteria that has infected wounds and prostheses and caused catheter-related sepsis in many troops returning home) and delaying evacuation out of theater were all reasons cited for not definitively repairing facial fractures in theater."

As from May 2005, a procedure called open reduction and internal fixation was introduced. This involves using mesh implants/plates to fix broken bones. For a patient to have this operation in Iraq he/she had to meet the following criteria׃

-- The fracture was exposed either by a wound, or by another procedure already being performed
-- Treating the patients in Iraq would not delay their evacuation from the theater of war
-- Treatment would allow them to stay in Iraq

Manuel A. Lopez, M.D., and Jonathan L. Arnholt, M.D., both from the Wilford Hall Medical Center, San Antonio, analyzed the records of 207 soldiers taken from the operating room by the otolaryngologist - facial plastic surgeon at the 332nd Expeditionary Medical Group at the Air Force Theater Hospital, Balad Air Base Iraq, during the period May-September 2005. The hospital is about 40 miles north of Baghdad, within the Sunni Triangle.

85% of them - 175 patients - were operated on for traumatic injuries, while 52 required open reduction and internal fixation of a facial fracture. 17 of the 52 patients were US military personnel who had undergone an open reduction and internal fixation. 8.3 months (average) after their procedures, 16 were followed up on the global military medical database.

The authors explain "None of these patients developed an Acinetobacter baumannii infection or had a complication caused by the definitive in-theater open reduction and internal fixation." In fact, just one patient needed revision surgical repair - this was due to high pressure in the skull.

The researchers wrote "The practice of definitively treating facial fractures in a war zone using the criteria discussed in this article can lead to improved patient outcomes. It has been shown that a delay in fracture fixation can lead to both increased technical difficulties and infectious complications."

As the muscles that surround an untreated facial fracture are fibrous and often contract, an untreated fracture can become more difficult to repair. Patients with jaw fractures which are not treated promptly are more likely to have complications, such as nerve weakness and misaligned teeth.

The authors concluded "Primary closure of soft tissue defects by open reduction and internal fixation of facial fractures on initial presentation to a well-equipped, in-theater hospital decreases the need for further facial surgery for patients when they return to the United States."

"Safety of Definitive In-Theater Repair of Facial Fractures"
Manuel A. Lopez, MD; Jonathan L. Arnholt, MD
Arch Facial Plast Surg. 2007;9(6):400-405
Click here to view Abstract online

Written by - Christian Nordqvist
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