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Objective: Our study aims to compare the prevalence of stunted growth in Syrian refugee children with cleft lip and/or palate (CL±CP) to other children with CL±CP of similar socioeconomic status. Design: A retrospective medical chart review. Setting: Center for Cleft and Craniofacial Surgery at a tertiary care hospital in Lebanon in the period between January 2013 and May 2019. Patients, Participants: One hundred three Syrian refugee children and 70 Lebanese children <18 years of low socioeconomic status who have CL, CP, or both. Interventions: These patients underwent cleft repair surgeries at our center. Main Outcome Measure(s): Stunted growth measured by calculating the height-for-age z-score (HAZ). Results: Using a confidence interval of 95%, the prevalence of stunting is significantly higher among Syrian refugees ( P < .003). The prevalence of stunting and age of presentation were positively correlated ( P < .02). There was no difference in stunting between patients with CP and CL ( P < .746). There was no difference in stunting between genders. Conclusions: The majority of Syrian refugee patients with CL±CP fall on the malnourished side of the nutritional spectrum as reflected by the high percentage of stunting as well as a mean of −1 for the HAZ.

Background In a high conflict region, war injuries to the distal lower extremity are a major source of large composite defects involving bone and soft tissues. These defects are at the edge between using a single free flap [osteo-(+/-myo) cutaneous] vs double free flap reconstruction (bone and soft tissue). In this paper, we present our experience and outcomes in treating patients with leg war injury reconstructed using a single free fibula flap. Methods Fifteen patients with distal leg composite defects secondary to war injuries were treated between January 2015 and March 2016. All patients were reconstructed using single barrel free fibula osteo-(+/-myo)cutaneous flap where single or double skin paddles were used according to the soft tissue defect requiring coverage. Results There were no cases of total or partial flap loss. Complications were limited to three cases including traumatic fibula fracture, venous congestion with negative findings, and residual soft tissue defect requiring coverage. There were no cases of wound dehiscence or infection. Mean follow-up time was 418.8 days. Mean bone healing time was nine months after which patients were allowed full weight bearing. Conclusion A single barrel free fibula osteo-(+/-myo)cutaneous flap is a valid and reliable tool for reconstruction composite lower extremity defects post-war injury. Adequate planning of fibula flap soft tissue components (skin, muscle) rearrangement is essential for success in such challenging reconstructions.

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Introduction: Syrian patients injured in the war frequently undergo rudimentary primary wound closure in combat zones. These patients are later transferred to Lebanon where their wounds need to be secondarily managed. This often leads to the creation of unorthodox approaches for reconstruction of orbital injuries. Case presentation: The authors of this manuscript demonstrate a few cases of peri-ocular trauma with a delayed presentation, in which adaptations of conventional reconstructive methods had to be implemented had to be undertaken for optimal results. Conclusion: Modified techniques for reconstruction of peri-ocular injuries with delayed presentation are discussed in this paper. The patients are cases of trauma secondary to war in the region of Lebanon and Syria. The unique presentations of these patients have led to the use of “opportunity flaps” surrounding highly fibrotic and scarred tissue, in an attempt to allow for delayed reconstruction.

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