Plastic Surgery at War: A Scoping Review of Current Conflicts

Abstract

Introduction The scope of military plastic surgery and location where care is provided has evolved with each major conflict. To help inform plastic surgeon utilization in future conflicts, we conducted a review of military plastic surgery-related studies to characterize plastic surgeon contributions during recent military operations. Materials and Methods Using a scoping review design, we searched electronic databases to identify articles published since September 1, 2001 related to military plastic surgery according to a defined search criterion. Next, we screened all abstracts for appropriateness based on pre-established inclusion/exclusion criteria. Finally, we reviewed the remaining full-text articles to describe the nature of care provided and the operational level at which care was delivered. Results The final sample included 55 studies with most originating in the United States (54.5%) between 2005 and 2019 and were either retrospective cohort studies (81.8%) or case series (10.9%). The breadth of care included management of significant upper/lower extremity injuries (40%), general reconstructive and wound care (36.4%), and craniofacial surgery (16.4%). Microsurgical reconstruction was a primary focus in 40.0% of published articles. When specified, most care was described at Role 3 (25.5%) or Roles 4/5 facilities (62.8%) with temporizing measures more common at Role 3 and definite reconstruction at Roles 4/5. Several lessons learned were identified that held commonality across plastic surgery domain. Conclusions Plastic surgeons continue to play a critical role in the management of wounded service members, particularly for complex extremity reconstruction, craniofacial trauma, and general expertise on wound management. Future efforts should evaluate mechanisms to maintain these skill sets among military plastic surgeons.

The use of machine learning for investigating the role of plastic surgeons in anatomical injuries: A retrospective observational study

“…[ 8 ] According to Fox et al, procedures performed by plastic surgeons include delayed primary suturing, tangential excision of necrotic tissue, skin graft or flap coverage, and release of secondary scar contractures to manage soft tissue injuries. [ 22 ] In our study, we found a strong relationship between the face and external injuries and plastic surgery, with the open reduction in the face area and the dressing in the external area being the most frequently performed procedures.…”

A quantitative analysis of trauma patients having undergone plastic surgery

“…The current imbalance of support in the form of government funding to the multidisciplinary approach remains a subject of criticism. Indeed, plastic surgeons are equipped with the skill sets required to address traumatic injuries, including management of soft-tissue injury, fractures in facial structures, neurovascular injury, and salvaging extremities [5][6][7][8]. Such critical role of plastic surgeons in trauma care is underrecognized due to regulations preventing them from serving as dedicated specialists, thereby depriving them of commensurate compensation.…”

“…However, thanks to much academic and clinical endeavor, plastic surgeons today play an integral role over a diversity of fields, from reconstructive to aesthetic surgery. Plastic surgeons are equipped with the skill sets required to address traumatic injuries, including management of soft-tissue injury, fractures in facial structures, neurovascular injury, and salvaging extremities [5][6][7][8]. Developments in diagnostic and therapeutic devices over the past 50 years, such as the evolution of imaging, microscope, dressing materials, and surgical instruments are also conducive to plastic surgeons' role in treating trauma patients [9].…”

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“…Despite the significant public health implications of violence-related limb injuries in conflict zones, there is a paucity of research focusing on the role of ortho-plastic teams in their management. Most existing data are based on studies conducted on military personnel or in high-income countries where resources are more readily available [ 13 , 14 ]. Furthermore, the unique challenges of conflict zones, such as the Gaza Strip, highlight the urgent need for building evidence out of these contexts.…”