Iraq War Has Led to Surgical Advances

Newswise — Through hard experience, U.S. military doctors and civilian surgeons in Iraq have made meaningful strides in managing devastating injuries suffered by soldiers and Iraqi victims. The gains are highlighted in special articles in the March issue of The Journal of Craniofacial Surgery published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

Writing onboard a C-17 MEDEVAC flight from Iraq, Col. W. Bryan Gamble, M.D., of the U.S. Army Medical Corps shares his "humbling" reflections on progress in the fields of trauma and critical care in the five years since the start of the Iraq War. Through intense co-operative efforts and ongoing changes to treatment guidelines and protocols, the survival rate for soldiers wounded in Iraq now exceeds 90 percent—"a monumental leap forward in survival from earlier conflicts," according to Dr. Gamble.

Ongoing data collection and analysis have led to continuous improvement in every area of trauma care. Among the many important innovations has been the introduction of civilian trauma experts and weekly video conferences to ensure continuity of care for injured soldiers throughout the Military Health System and into the Veterans' Administration system.

As soldiers survive combinations of injuries that would not previously have been survivable, unprecedented surgical insights have emerged. For example, relatively simple measures to avoid hypothermia have significantly increased body temperatures by the time wounded soldiers arrive at combat hospitals—thus improving their chances of survival.

"Constant and critical analysis of fundamental patient data points can lead to profound changes and improvement in survival," Dr. Gamble writes. "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."

On the ground in Iraq, Dr. Raja K. Kummoona writes of the experience in treating civilians with missile injuries—caused by bullets, shrapnel, etc.—to the face and mouth area at the Hospital of Specialized Surgery in Baghdad. During the first two years of the war, Dr. Kummoona's unit operated on 141 patients with missile injuries of the orofacial region.

Dr. Kummoona outlines his unit's surgical approach, including the use of bone grafts to reconstruct the mandible (lower jaw) and soft tissue reconstruction of the lips and cheeks. The injuries are characteristics of the ongoing conflict in Iraq, which Dr. Kummoona characterizes as "a combination of war crime and assault, and civil unrest and terrorism." He writes, "As surgeons, we cannot influence the surge of this violence, but we are surely called upon to care for its victims."

In a Special Editorial, Dr. Mutaz B. Habal, Director of Tampa Bay Craniofacial Center in Tampa, Fla., and Editor-in-Chief of JCS, underscores the need to integrate the knowledge of military and civilian surgeons so as to improve outcomes for the casualties of modern war.

Lessons from the experience of military surgeons will be applicable to the daily practice of civilian craniofacial surgeons in treating patients with head injuries, Dr. Habal believes. Some of the techniques evolved in treating Iraq War casualties—for example, preservation of skull bone for use in later reconstruction—may also have implications for reconstructive surgery in patients with certain brain tumors or extensive skin cancers. Dr. Habal concludes, "The final is a constant learning experience between the civilian surgeons and the military surgeons to treat the young people injured for their improved outcome, which we are witnessing as we write these lines."

About The Journal of Craniofacial SurgeryThe Journal of Craniofacial Surgery serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 13 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Brazilian Society of Craniofacial Surgeons, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

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