The surgical management of facial trauma in British soldiers during combat operations in Afghanistan

Skill sets required for the management of military head, face and neck trauma: a multidisciplinary consensus statement

“…Some British authors stated that wounds should be cleaned, decontaminated and repaired by delayed primary closure 11 16 18. However, a comprehensive review of all British military facial injuries identified that debridement and primary direct closure under antibiotic cover failed to show any cases of postoperative infection 12. The use of both internal and external fixation techniques for maxillofacial fractures was described by British and American military surgeons for the early management of ballistic wounds 9 10 17 18.…”

Analyses of Combat-Related Injuries of Maxillofacial and Cervical Regions and Experiences in Operational Field Hospital

“…[9] Lawnick et al [8] noted that MCIS showed superior performance compared with AIS because its source was rooted in combat injury databases. In addition, Wordsworth et al [10] concluded that AIS cannot predict the need for reconstructive surgery for combat-related maxillofacial injuries. The development of MCIS and MFIS included five combat body regions, injury severity along a five-point scale, injury descriptions for a spectrum of combat-related injuries, and injury description codes.…”

“…There was no statistically significant difference between the HEED and LBW groups with regard to MCIS scores (p=0.206). Wordsworth et al [10] concluded that the maxillofacial region is commonly injured during blasts. Similarly, in this study on modern conflicts, which occur in narrow places and near urban areas, maxillofacial and cervical injuries are commonly observed because of the use of HEEDs like IEDs.…”

“…Much of the literature suggests that early intervention is necessary for patients who have suffered from maxillofacial and cervical trauma. [6,10,12,[14][15][16] Similarly, we suggest that primary life-saving procedures should be performed in the operational field hospital along with a multidisciplinary evaluation of the patient and surgical procedures for hemorrhage, splint stabilization, or rigid fixation of the facial bony framework; closure of the primary soft tissue; and securing the airway. The standard ABCs of trauma care should apply to the patients with maxillofacial and cervical injuries, and the primary goal of treatment for maxillofacial injuries is early conservative repair, with an emphasis on symmetrical and functional facial contours.…”

Facial injury management undertaken at US and UK medical treatment facilities during the Iraq and Afghanistan conflicts: a retrospective cohort study

“…The UK deployed surgeons formally trained in the management of facial trauma to the R3 MTF in Camp Bastion and, for a shorter period, to the Canadian-led R3 MTF in Kandahar 6–9. Taught British practice was to repatriate patients with facial injury without stabilisation or fixation of the facial skeleton to the Royal Centre for Defence Medicine (RCDM) in Birmingham UK (role 4) 6 7 10–13…”