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In-the-Field Facial Surgery Helps Injured Troops in Iraq

No evacuation delays mean quicker, better surgeries, study finds

TUESDAY, Nov. 20 (HealthDay News) -- U.S. troops in Iraq who have suffered facial wounds are now undergoing successful reconstructive surgeries at army facilities in the field -- cutting their risk for long-term complications caused by evacuation-linked delays.

In the past, concern about potentially deadly infections has made field physicians hesitant to repair face wounds in Iraq, explained co-researcher Dr. Manuel L. Lopez, a head and neck surgeon who had been with the 322nd Expeditionary Medical Group at Balad Air Force Base, north of Baghdad.

That meant that wounded troops would have treatment delayed for the two or three or more days needed for evacuation to hospitals in Germany or the United States, he said.

Evacuation has its downside, however, because "any time you do [a surgery] faster, the greater the chance for optimum results," Lopez said.

What turned the tide was experience with Iraqis who were treated for the same kind of facial wounds at the base. Evacuation was not possible for them, so the surgeons just went ahead and operated.

Reporting in the November/December issue of Archives of Facial Plastic Surgery, the team found that risk of infection in such operations was much lower than had been previously thought.

Starting in May, 2005, American soldiers meeting strict guidelines began to have their facial fractures repaired in Iraq, in a procedure known as "open reduction and internal fixation." This techniques uses mesh implants or plates to mend broken bones.

About 60 percent of wounded American troops in Iraq suffer head and neck injuries, often severe. "The kind of trauma these kids experience with the high-velocity impact can be tremendous," Lopez said.

In the report, facial plastic surgeons operated on 207 people at the hospital, with 52 requiring open reduction and internal fixation of a facial fracture.

"We were able to treat them acutely, so bacteria were not at the level where they overcome the patient," Lopez said. He wrote the paper with Dr. Jonathan L. Arnholt, another plastic surgeon at the 322nd, who, like Lopez, is now at the Wilford Hall Medical Center in San Antonio. Lopez is chief of facial plastic surgery at Wilford Hall.

Lopez said he had not been keeping records of on-the-spot facial surgery in Iraq since he left the area. "But we're trying to work on it," he said. "We keep asking people there for numbers. Anecdotally, I can tell you that those people are following the criteria."

Troops who suffer facial wounds often require extensive long-term care, said Dr. Catherine Wilson, who was chief of facial and plastic reconstructive surgery at Walter Reed Army Medical Center in Washington for four years. She now is in private practice in Carmel, Ind., and is a clinical professor of otolaryngology at Indiana University.

"Even in my practice now, I am seeing a lot of long-term issues with aggressive scarring," Wilson said. "Five years out from the injury, you need top-notch surgery to maintain the outcomes."

Extensive scarring can be a continual problem for some patients, Wilson said. "I have several of them in my practice now, and some troops need multiple procedures," she said.

Getting troops to surgery faster after a face wound can reduce the need for such drastic longer-term care, Lopez said.

"One thing the military has definitely done right in this war is patient care and movement," he said.

More information

Learn more about military medicine from the Uniformed Services University.

SOURCES: Manuel L. Lopez, M.D., chief, facial plastic surgery, Wilford Hall Medical Center, San Antonia; Catherine Wilson, M.D., plastic surgeon, Carmel, Ind.; November/December 2007, Archives of Facial Plastic Surgery

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