Experiences of a Deployed Plastic Surgeon within the Modern War Theater

Introduction:  Plastic surgeons have been actively serving within deployed war theater operations since the start of the Global War on Terrorism in 2001.¹  However, the majority of reconstructive procedures are postponed until the casualty is evacuated from the combat environment to a tertiary care facility in the United States.  Procedures within theater are usually reserved for resuscitation, stabilization, and damage control surgery.  A recently deployed plastic surgeon’s experiences and cases will be outlined and discussed with an update on the prior three years of collective experiences also illustrated. 

Methods:  All combat casualty and non-combat related injury cases performed at a major trauma hospital within Afghanistan were reviewed and compiled.  Data assessed included major and minor cases further sub-categorized into body region treated.

Results:  From 2009-2012, a total of over 10,000 trauma admissions were evaluated with 84% of these being “point of injury” combat casualties.  Despite seasonal variation in war trauma care, on average, more than 500 surgical cases and 1600 operative procedures were performed monthly at this facility.  During the prior 6 months, the plastic surgeon contributed to over 416 surgical cases.

Procedures
Head/Neck	n	Thoracic	n
Facial lacerations	50	Chest tubes	22
Craniectomy/craniotomy/cranioplasty	17	Thoracotomies	7
Facial fractures	14	Extremity
Eye injury/repair	11	Amputations	27
Facial flaps	7	Acute limb salvage	9
Tracheostomies	5	External fixators	9
Facial nerve exploration	2	Tendon repair	9
Abdominal		Arterial repair	8
Exploratory laparotomies	18	Hand fractures	6
Appendectomies	13	Pedicle flaps	6
Perineal/scrotal injuries	12	Free flaps	1
Small bowel repair/resection	10	Other
Abdominal wall repair	5	I&D	58
Trunk flaps	4	Central lines	45
PEG	4	Benign lesion excision	24
EGD	2	Local tissue rearrangement	24
		Burns	6
		Bone grafts	6
		External tissue expanders	5

Conclusion:  The Global War of Terrorism has provided over a decade of war trauma experience for our military plastic and reconstructive surgery teams.  Besides the ongoing efforts with our stateside military practices, highlights of our surgeons’ contributions to the active in-theater war operations and trauma centers are illustrated to provide a glimpse of the unique experiences gained in recent years.