The author reviews his surgical experience while deployed for 6 months with the US Army to a Combat Support Hospital in Afghanistan. The hospital provided care to US Soldiers, Afghan Army, and Local Nationals. There were two operating rooms, an eight bed ICU, and a twenty-five bed ward. The hospital received casualties from across the entire Afghanistan theater. Trauma stabilization and evacuation was performed on US Soldiers. Afghan Army and Local Nationals received definitive care.

During the deployment 121 cases were performed. Ninety percent were trauma related. Trauma cases included: 33 head/neck with 11 cranial ORIF, 13 Facial fracture ORIF, two CSF leak repairs, seven soft tissue repairs. Thirty were upper extremity, nine trunk, and 31 lower extremity, including 27 flaps (two free flaps), 11 skin grafts, and 22 wound closures. Ten percent were elective: nine percent humanitarian, including cleft/craniofacial, and burn reconstruction. One scar revision was performed.

Of 109 trauma cases, complications were as follows: craniofacial- mortality 1/11 craniotomies, one persistent CSF leak, one craniofacial hardware removal for infection of 24 cases. With Flaps there was one partial flap loss, one delayed healing, two cellulitis, and one hematoma. Skin grafts had 1/11 lost. From Acute burns there was one death, one skin graft loss in an infant with 46% TBSA full thickness burns. Of the wound closures, there was one cellulitis. There was one partial SG loss, from the twelve elective cases,

Challenges encountered while delivering care in a Combat Zone included poor patient nutrition, large zones of injury from high velocity weapons, transport times to definitive care, and equipment shortcomings. Given the small open bay ICU/ward environment at the hospital, wound contamination was of greater concern.

In a Combat Support Hospital within the austere environment of Bagram, Afghanistan, plastic surgical care was successfully delivered to US Soldiers, Afghan Army, and civilians. Plastic Surgeons are uniquely qualified to assist with the wide variety of traumatic and humanitarian cases presenting within a Combat Theater.