ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Unintended Consequences: Combat-related injuries lead to advances in facial plastic and reconstructive surgery

by Jennifer Decker Arevalo, MA • February 1, 2010

  • Tweet
  • Email
Print-Friendly Version

In a 2007 report, Dr. Lopez described how, prior to 2005, most military personnel with facial fractures were air evacuated from AFTH (Arch Facial Plast Surg. 2007;9(6):400-405). These patients received definitive treatment of their wounds with open reduction and internal fixation (ORIF), because of concerns about sterility, infection from Acinetobacter baumannii, and delayed evacuation out of theater.

You Might Also Like

  • Facial Plastic and Reconstructive Surgery: New Patients, New Reasons, New Techniques
  • Wound Management Following Facial Plastic Surgery
  • Trends in Facial Plastic Surgery: New Patient Groups Bring New Challenges
  • The Revolution and Evolution of Free Flaps in Facial Reconstructive Surgery
Explore This Issue
February 2010

Dr. Lopez, however, reported that definitive treatment of facial fractures with ORIF might be feasible and safe in theater if certain criteria were met:

  • The fracture site was exposed through either a soft tissue wound or because of an associated approach (e.g., a frontal sinus fracture exposed by a bicoronal flap during a decompression craniectomy)
  • Definitive treatment of the fracture would not delay evacuation from the theater
  • Treatment of the facial fracture would allow the patient to remain in theater

Delaying fracture fixation can increase infections, as well as technical difficulties, as surrounding facial muscles contract. Delayed treatment of jaw fractures may increase the odds of marginal nerve weakness and malocclusion. According to Dr. Lopez, primary closure of soft tissue defects by ORIF 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 U.S.

Drs. Lopez and Holt agree that long-term reconstruction of badly traumatized faces will be advanced in the civilian community because of the experience gained by military surgeons and reported in specialty journals.

“Additionally, in Iraq and Afghanistan, local wound contaminants, such as Acinetobacter baumannii, can be an issue,” Dr. Holt said. “For U.S. civilians, it is methacillin-resistant staphylococcus aureus (MRSA). From Dr. Lopez’s work in closing wounds in Iraq using high-dose antibiotics and excellent attention to wound debridement and handling, more confidence is gained in the treatment of MSRA-contaminated wounds of the face, scalp and neck, and we can apply the same principles of care to this group of patients in the U.S.”

Certainly the evidence base from caring for these military wounds will enhance civilian care of traumatized patients, including those with head and neck and maxillofacial trauma.
—Richard Holt, MD

Neck Exploration

Data from the US Navy-Marine Corp Combat Trauma Registry reveals that almost 61 percent of all patients wounded during Operation Iraqi Freedom (OIF) have a head and neck wound and 65 percent of all HFNIs are to the face. The registry lists improvised explosive devices (IEDs) as the most frequent cause of HFNIs. IED shrapnel sprays upwards, causing complex facial lacerations, specifically small holes in the head and neck—areas not well protected by body armor. Although these high-velocity projectiles appear to just “nick” the skin, in reality they create serious pathology in the vascular structures of soft and hard tissues that can be difficult to detect.

Pages: 1 2 3 4 5 | Single Page

Filed Under: Departments, Facial Plastic/Reconstructive, Head and Neck, Medical Education, Practice Focus Tagged With: antibiotics, facial, head and neck, infection, reconstructive, research, surgery, warIssue: February 2010

You Might Also Like:

  • Facial Plastic and Reconstructive Surgery: New Patients, New Reasons, New Techniques
  • Wound Management Following Facial Plastic Surgery
  • Trends in Facial Plastic Surgery: New Patient Groups Bring New Challenges
  • The Revolution and Evolution of Free Flaps in Facial Reconstructive Surgery

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Experts Delve into Treatment Options for Laryngopharyngeal Reflux
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Weaning Patients Off of PPIs
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Vertigo in the Elderly: What Does It Mean?
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Podcasts Becoming More Popular Method of Education for Otolaryngologists
    • How to Embrace Optimism in the Midst of the COVID-19 Pandemic
    • Tips on How to Approach Conversations with Patients about the COVID-19 Vaccine
    • Steps You Should Take to Protect Your Voice and Hearing During Telemedicine Sessions
    • Routine Postoperative Adjunct Treatments Unnecessary for Idiopathic Cerebrospinal Fluid Leaks

Polls

Have you spoken with your patients about receiving the COVID-19 vaccine?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2021 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.