The surgical management of facial trauma in British soldiers during combat operations in Afghanistan
Section snippets
Background
As the weapons of war change so do the patterns of injury. In World War One the troops in the trenches sustained horrific facial injuries from shrapnel that required surgeons to try new combinations of techniques forming the basis of modern plastic surgery [1]. United Kingdom service personnel were operating in Afghanistan as part of International Security Assistance Forces (ISAF) from 2001 on Operation HERRICK. The Improvised Explosive Device (IED) was the defining weapon used against ISAF in
Patients and methods
The UK Joint Theatre Trauma Registry (JTTR) is a restricted database of all injuries sustained by British service personnel admitted to a Field Hospital on operations [12]. The JTTR uses the Abbreviated Injury Scale (AIS) as an anatomical scoring system to code every injury, the military version of AIS 2005 was used [13].
The face in the JTTR includes facial skin and soft tissues, the maxillofacial skeleton, eyes and ears. Injuries to the scalp, head and neck are separately coded. For the
Results
A total of 633 UK service personnel with facial injury were identified. Blast injury accounted for 563 of the facial injuries and gunshot wounds (GSWs) for 70. 59 blast injury casualties were excluded after suffering isolated tympanic membrane perforation and no other facial injury. 8 facial GSWs were excluded as the facial injury itself was not related to the GSW or miscoded. Therefore a total of 504 blast injuries and 62 GSWs were further studied. There were 405 survivors (wounded in action)
Mechanism of injury
The predominant mechanism of injury in both survivors and fatalities was the IED. The type of gunshot injury was not specified. All mechanisms are listed in Table 2.
UK hospital care
In the blast cohort 136 soldiers required facial and/or ophthalmic surgery at the Royal Centre for Defence Medicine. There were a total of 230 operations for these patients, a mean of 1.7, range of 1–8. Multiple staged reconstructive facial surgeries were required in 21 (16%) of these patients. This was predominantly eyelid (n = 7) and nasal (n = 9) reconstructions. There were 3 free flaps and 7 local flaps used in facial reconstructions in this group.
In the GSW cohort 20 soldiers required further
Discussion
Complex injuries from improvised explosive devices were the hallmark of the conflict in Afghanistan [14]. Typically the blast wave is from underneath the soldier, whether on foot or mounted in a vehicle [15], which would explain why lower limb injuries were most commonly associated with facial injuries in blast victims and why the pattern of injury was predominantly affecting the mid and lower face.
From this data it appears that in this conflict the pattern of blast injury to the face is
Conflict of interest statement
There are no other potential conflicts of interests.
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