Plastic Surgery and the War on Terror

Rate This

Much has been written about the fact that the field of plastic surgery advances in wartime. Indeed, treating wounds sustained in battle poses some of the most difficult challenges imaginable for plastic surgeons, said the American Society of Plastic Surgeons, including “shattered jaws, blown off noses and lips and gaping skull wounds.”

The ASPS noted that World War I helped usher in the modern age of plastic surgery. The organization explained that the weaponry of the day required innovation in reconstructive procedures, and surgeons from the United States and Europe rose to the occasion. They not only gave the wounded the best possible chance of living a normal life after war, the lessons the physicians learned also contributed to modern techniques for rhinoplasty and other cosmetic surgeries.

Today’s “war on terror” brings with it more formidable challenges for surgeons than ever before. High-energy blast devices such as IEDs deliver devastating trauma to skin, muscle and bone. At the same time, techniques for saving lives in the field continue to improve. The result is that the reconstructive skills of today’s plastic surgeons are being tested to an extreme. And they are responding in amazing ways—achieving astonishing results and, as in the past, sharing what they learn with the world.

For a taste of some of this work, browse a paper published last year by three military plastic surgeons (see link below), Anand R. Kumar, Raymond Harshbarger and Barry Martin. The three physicians present two cases to illustrate typical reconstructive work confronting plastic surgeons who operate on soldiers: a massive craniofacial injury and a major torso/extremity wound. In both instances, as in many devastating wounds suffered in battle today, advanced triage techniques saved the patient’s life and reconstruction was delayed for months.

The first soldier profiled in the paper entitled “Plastic Surgery Challenges in War Wounded” sustained extensive head wounds, losing a large amount of tissue and part of his skull. His surgical team reconstructed the entire front portion of the top of his head using plastic and titanium material to protect the brain and restore a more natural shape to the forehead.

The second case presented by the three plastic surgeons is that of a marine who suffered a massive blast wound to the lower torso, exposing angry looking, red subcutaneous tissue and bone in his lower back. His posterior was reconstructed using tissue expanders to stretch the lower back skin, then re-covering the gaping wound and suturing the skin in place. But for the side-to-side scar across his back, his rear now looks next to normal.

How will the experiences of today’s reconstructive surgeons advance the field of plastic surgery? In their paper, the three surgeons cited achieving good outcomes with “novel approaches” to skin flap reconstruction, bone grafting and bone engineering. They emphasize the importance of creating a clean wound bed and using replacement tissue with a healthy blood supply. These lessons will make their way into current reconstructive and cosmetic practices, perhaps increasing surgical options and paving the way for even better results for some patients.

One of the most interesting findings reported is that the delay patients experience from initial care to reconstruction does not hinder the eventual restoration of form and function. In fact, doctors Kumar, Harshbarger and Martin demonstrate a low skin flap failure rate compared to more routine plastic surgery and orthopedic surgery, in addition to low infection rates. This knowledge may influence the way plastic surgeons view revision cases and some staged operations, including breast reconstruction.

There’s not much good to say about war. Especially in hindsight, many armed conflicts just don’t seem worth the horrific cost in shattered lives. The incredible advances in medical knowledge achieved during wartime are one bright spot.

Resources:

http://www.plasticsurgery.org/About_ASPS/History_of_Plastic_Surgery.html

http://www.liebertpub.com/DContent/Files/SampleChapters/Sample_AdvancesinWoundCareVolume1.pdf

Add a CommentComments

There are no comments yet. Be the first one and get the conversation started!

Cathy Enns View Profile Send Message

We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.