Facial fractures can be repaired in war zones

Last Updated: 2007-11-20 14:50:24 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The results of a new study suggest that soldiers who sustain a facial fracture can have the injury safely and definitively repaired in the war zone.

According to the report, which appears in the Archives of Facial Plastic Surgery, up to 61 percent of patients wounded during Operation Iraqi Freedom have sustained a head and neck injury.

Prior to May 2005, most patients with a facial fracture were air evacuated to a center away from the theater of war for definitive treatment, study authors Dr. Manuel A. Lopez and Dr. Jonathan L. Arnholt, from the Wilford Hall Medical Center in San Antonio, note. This was largely due to concerns about sterility and infection with Acinetobacter baumannii, in particular, and that treatment would delay their evacuation from the war zone.

In May 2005, however, surgeons began using open reduction and internal fixation (ORIF) to repair serious facial fractures without evacuating patients from the theater of war, provided certain criteria were met.

Most facial fractures are treated with a "closed" reduction in which the bones are reset without making an incision and an external splint is placed. With more severe fractures, an open reduction is performed in which an incision is made to perform the repair in which the broken facial bones are secured with screws, plates and sutures.

Criteria for operation in the war zone included:

--The facial fracture was exposed by a wound or by another operation already being performed.

--Treatment in Iraq would not delay evacuation from the war zone.

--Treatment would allow the patient to continue service in the war zone.

Between May and September 2005, a total of 207 patients underwent 388 facial plastic procedures. In 175 of these patients, the operation was performed for a traumatic injury, including 52 patients who underwent ORIF of a facial fracture.

Seventeen of the 52 ORIF-treated patients were American military personnel. Sixteen of these patients were available for follow-up for an average of 8 months; no cases of A. baumannii infection or ORIF-related complications were seen.

"Although it was initially appropriate to delay the definitive surgical repair of facial fractures until the wounded were air evacuated out of theater, it has now been shown that delaying treatment is no longer warranted. Definitive treatment of facial fractures with ORIF in American soldiers is advised when the aforementioned criteria are applied," the authors conclude.

SOURCE: Archives of Facial Plastic Surgery, November/December 2007.