Iraq War Has Led to Surgical Advances

Through hard experience, U.S. military doctors and civilian surgeons in Iraq have made meaningful strides in managing devastating injuries suffered by soldiers and Iraqi victims. The gains are highlighted in special articles in the March issue of The Journal of Craniofacial Surgery published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.

Writing onboard a C-17 MEDEVAC flight from Iraq, Col. W. Bryan Gamble, M.D., of the U.S. Army Medical Corps shares his "humbling" reflections on progress in the fields of trauma and critical care in the five years since the start of the Iraq War. Through intense co-operative efforts and ongoing changes to treatment guidelines and protocols, the survival rate for soldiers wounded in Iraq now exceeds 90 percent—"a monumental leap forward in survival from earlier conflicts," according to Dr. Gamble.

Ongoing data collection and analysis have led to continuous improvement in every area of trauma care. Among the many important innovations has been the introduction of civilian trauma experts and weekly video conferences to ensure continuity of care for injured soldiers throughout the Military Health System and into the Veterans' Administration system.

As soldiers survive combinations of injuries that would not previously have been survivable, unprecedented surgical insights have emerged. For example, relatively simple measures to avoid hypothermia have significantly increased body temperatures by the time wounded soldiers arrive at combat hospitals—thus improving their chances of survival.

"Constant and critical analysis of fundamental patient data points can lead to profound changes and improvement in survival," Dr. Gamble writes. "Application of these lessons into training doctrines for standards of practice will ensure optimal outcomes for our patients of today and into the future for soldiers and civilians alike, should the need ever arise."

On the ground in Iraq, Dr. Raja K. Kummoona writes of the experience in treating civilians with missile injuries—caused by bullets, shrapnel, etc.—to the face and mouth area at the Hospital of Specialized Surgery in Baghdad. During the first two years of the war, Dr. Kummoona's unit operated on 141 patients with missile injuries of the orofacial region.

Dr. Kummoona outlines his unit's surgical approach, including the use of bone grafts to reconstruct the mandible (lower jaw) and soft tissue reconstruction of the lips and cheeks. The injuries are characteristics of the ongoing conflict in Iraq, which Dr. Kummoona characterizes as "a combination of war crime and assault, and civil unrest and terrorism." He writes, "As surgeons, we cannot influence the surge of this violence, but we are surely called upon to care for its victims."