Professional Documents
Culture Documents
doi:10.1016/j.coms.2005.05.003
In the early days of World War I, a young surgeon from New Zealand stationed in Aldershot,
England was inundated by horrendous wounds to
the head and neck of soldiers returning from the front
lines. Because of advances in ballistics and weaponry,
coupled with the fact that trench warfare necessitated
the soldiers to place their maxillofacial region at great
risk to monitor the status of the enemy, this surgeon
was faced with injuries never before encountered.
His name was Harold Delf Gillies, and his contributions to the medical community are universally
accepted as the initiation of the discipline of plastic
and reconstructive surgery [1,2]. Hippocrates once
famously told his students, War is the only proper
school for surgeons. Unfortunately, the experiences
undergone since September 11, 2001 have provided a
whole generation of military surgeons the opportunity
to treat a new type of injury pattern never before seen
[3]. Improved body armor, which allows soldiers to
survive wounds that would have been fatal 2 to 3 years
earlier, and the catastrophic and new injury patterns
sustained by improvised explosive devices (IEDs)
oralmaxsurgery.theclinics.com
Department of Oral and Maxillofacial Surgery, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base,
2200 Bergquist Drive, Suite 1, San Antonio, TX 78236-9908, USA
b
Department of Oral and Maxillofacial Surgery, Walter Reed Army Medical Center, Washington, DC 20327, USA
c
Department of Oral and Maxillofacial Surgery, National Naval Medical Center, Bethesda, MD 20889, USA
d
Department of Oral and Maxillofacial Surgery, National Naval Medical Center, San Diego, CA 92127, USA
Although this should be intuitive, in a mass casualty or acute trauma situation the basics of medical care should be emphasized, because these actions
undoubtedly will save lives. Securing the airway
by whatever means necessary, including endotracheal intubation or surgical airway, should be performed immediately if there is any doubt about future
stability of the patient. A true disaster scenario easily could overwhelm the ability of a medical care
facility to monitor the condition of victims with possible or suspected future airway compromise. Bleeding should be controlled and volume expansion
should be accomplished to maintain perfusion of the
vital organs by blood transfusion, blood substitutes,
Identification of injuries
powers et al
1. Stabilize patient
2. Identify injuries
3. Obtain radiographic studies and
stereolithographic models
4. Initiate consultations (eg, psychiatry, physical therapy, speech
therapy)
5. Initiate cultures/sensitivities
(infectious disease consultations)
6. Unidertake serial de
bridement
(days 3 10) to remove necrotic
tissues
7. Stabilize hard tissue base to support soft tissue envelope and prevent scar contracture before
primary reconstruction
8. Conduct comprehensive review of
stereolithographic models and
radiographs and determination of
treatment goals
9. Replace missing soft tissue component (if necessary)
10. Perform primary reconstruction
and fracture management
11. Incorporate aggressive physical/
occupational therapy
12. Perform secondary reconstruction
(eg, implants, vestibuloplasty)
13. Perform tertiary reconstruction
(eg, cosmetic issues,
scar revisions)
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