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Innovative Care Is Helping Iraq War's Injured Survive

Improvements mean 9 out of 10 with serious trauma live, often with little visible damage, surgeons say

MONDAY, March 24 (HealthDay News) -- After five years of war in Iraq, there's some relatively good medical news about the casualties over there: more than 90 percent are now surviving injuries that would have been fatal in previous conflicts.

In the March issue of The Journal of Craniofacial Surgery, the surgical and treatment advances behind these gains are discussed in special articles by craniofacial surgeons who specialize in head and facial trauma injuries -- cases involving noses and lips ripped away in bomb blasts, skulls and jaws shattered by bullets, and skin sheared off by burning debris.

"Trauma that results from war, and trauma we see in hospital wards from car crashes, gang fights and more, are two different things. But by integrating the knowledge of military and civilian surgeons we are improving outcomes for the casualties of modern war and saving the lives of people who would never have survived years ago," said Dr. Mutaz B. Habal, director of the Tampa Bay Craniofacial Center in Tampa, Fla., and the journal's editor-in-chief.

According to surgeons who reported their experiences in the journal, changes to treatment guidelines and protocols based on surgical insights, ongoing data collection and analyses have resulted in better treatments for the wounded. In addition, the introduction of civilian trauma experts and weekly video conferences have improved continuity of care for injured soldiers throughout the Military Health System and into the Veterans' Administration system.

"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," wrote JCS contributor Col. W. Bryan Gamble, M.D., of the U.S. Army Medical Corps.

The journal also reports how relatively simple measures to avoid extreme loss of body heat, hypothermia, before wounded soldiers arrive at combat hospitals have significantly increased survival times.

Wounded soldiers are also transported to hospitals more quickly than ever before, thanks to C-17 Medevacs. "They are really flying ICUs with 12 beds, equipment for resuscitation, IV fluids and more. Just as an ambulance does on the civilian side, the C-17 Medevacs provide damage control," said Habal, who was an army reserve colonel called to active duty during the first Iraq conflict, Operation Desert Storm.

Using advanced trauma care and surgical techniques, craniofacial surgeons have made important strides in managing the often devastating head and face injuries suffered by not only US soldiers but Iraqi civilians.

For example, Iraqi surgeon Dr. Raja K. Kummoona writes in the JCS on his experience treating 141 patients at the Specialized Surgeries Hospital in Baghdad. Many suffered from severe facial injuries caused by projectiles such as bullets and shrapnel. He outlines his unit's surgical approach, which includes using bone grafts to reconstruct the mandible (lower jaw) and soft tissue reconstruction of the lips and cheeks.

"One 13-year-old girl had a severe injury involving the floor of her mouth, tongue and lower face caused by a rifle bullet at close range. She was brought to the hospital and we controlled her airway, blood pressure and bleeding and then immediately reconstructed the soft tissue, stabilized the bony fragments in position. We were able to restore her face," said Kummoona.

"We've learned the early operative repair of the orofacial region and the reconstruction of the soft tissue position is critical in obtaining optimal aesthetic and functional results. We've also found it is important that the remaining segments of the maxilla and mandible be held in an anatomic position through the period of soft tissue and bone reconstruction to limit the magnitude of the deformity," he stated.

The results, revealed in photos that accompany the journal articles, are remarkable. They show horribly scarred and misshapen faces transformed into faces that often appear virtually normal.

Atlanta plastic surgeon Dr. Edwin C. Pound, who travels on volunteer missions each year to third world countries to perform reconstruction and repair surgeries, said war is an unfortunate but good teacher for surgeons.

"You see injuries you would never imagine otherwise and surgeons are placed in the position of having to find ways to do the reconstructions," Pound said. "The very growth of plastic surgery, in fact, grew out of reconstructive techniques developed in World War II to help soldiers with craniofacial injuries."

More information

For more on reconstructive surgeries, visit American Society of Plastic Surgeons.

SOURCES: Mutaz B. Habal, MD, director, Tampa Bay Craniofacial Center, Tampa, Fla.; Raja K. Kummoona, MD, craniofacial surgeon, Hospital of Specialized Surgery, Baghdad, Iraq; Edwin C. Pound, III, MD, plastic, maxillofacial, cosmetic and hand surgeon, Atlanta, Ga.; March 2008 Journal of Craniofacial Surgery.

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