Forward trauma surgery in Afghanistan: lessons learnt on the modern asymmetric battlefield.

The deployment of 16 Air Assault Brigade to Helmand Province, Afghanistan in April-October 2006 was supported by a two -surgeon Field Surgical Team (FST) embedded within a 25 bed medical facility. We report the summative operative experience of the FST in order to analyse workload, case-mix and outline future training requirements. Within this period, 138 patients underwent 255 theatre episodes and 322 surgical procedures. 106 of the 138 patients requiring surgery were battle-injured. Surgical procedures undertaken involved wound excision (95), major amputation (9), laparotomy (9), application of external-fixation/skeletal traction (6), thoracotomy (4), plaster application (6), dural repair (2), and one tracheostomy with 13 other procedures. Procedures undertaken at subsequent surgery included delayed primary closure (65), split skin graft (7), wound excision (5), tendon repair (3) and 32 others. Complications included two patients with delayed reactionary haemorrhage/ post-surgical bleeding requiring re-operation. There was one in-hospital death. Thirty-two patients underwent surgery to treat disease or non-battle injury (DNBI), including 9 patients with major burns who required 26 procedures for burn excision and primary skin grafting. Many of the operations required the deployed team to operate outside of their normal NHS comfort zone. The experiences and lessons learnt and re-learnt by this surgical team should be part of our institutional memory.