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.
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.