Plastic and reconstructive surgery management of civilians and military injuries during the 2023-2024 Middle East conflict.

BACKGROUND

On October 7, 2023, a large-scale regional attack amid an armed conflict in the Middle East, resulting in an unprecedented number of wounded civilians and soldiers. Medical centers faced the challenge of managing a large influx of trauma patients on the day of the attack and throughout the ensuing conflict. This study presents our plastic surgery team's experience in immediate and reconstructive care highlighting key lessons learned.

METHODS

This retrospective study includes data on war-related injuries treated by our Plastic Surgery team from October 7, 2023, to June 1, 2024. Treatment varied by injury type and severity, with patients receiving care solely by plastic surgeons or within a multidisciplinary team. Data included demographics, injury types, wound management, complications, and microbiology.

RESULTS

Seventy-two patients with 132 wounds were included, predominantly involving the extremities, with lower limbs most frequently affected (53%). Blast-related shrapnel injuries were the leading mechanism (68%). One-third of wounds demonstrated bacterial growth, predominantly Gram-negative organisms. While a subset of wounds healed by secondary intention, most required surgical intervention, often following a staged approach. Notably, immediate closure performed by non-plastic surgery teams was associated with a complication rate of 72%, compared to 18% and 17% for immediate and delayed closure performed by the plastic surgery team, respectively (p < 0.001). Overall, early primary closure was associated with significantly higher complication rates compared to delayed closure or reconstructive techniques (p = 0.025), further supporting the importance of specialist involvement in closure decision-making.

CONCLUSION

Plastic surgery plays a pivotal role in the management of traumatic wounds, addressing both acute injuries and delayed reconstruction. Early involvement of plastic surgeons in the management of war-related injuries is essential for optimizing decision-making through careful wound assessment and appropriate timing of closure, ultimately improving outcomes.