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Abstract Background War causes severe suffering and harm to the civilian population. Knowledge about civilian injury patterns constitutes a part of the dimensioned planning and preparedness for medical care and civilian defence in times of war. This systematic review is conducted on request from The Swedish National Board of Health and Welfare and includes civilian injury patterns in modern war. Methods The aim of the study is to describe civilian injury patterns in war 1973–2023. We have conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The protocol has been registered 2023-05-06 in PROSPERO (CRD4202321483). Results The search resulted in 3455 identified articles. 1226 of those were duplicates. 2229 studies were assessed, and 1817 papers were excluded. 412 papers went through full text assessment resulting in 63 remaining papers. Injuries to the extremities constitutes 50%, followed by head injuries (26%) and injuries to the chest (18%). Notably, 23% of the wounded are children. Discussion There is no standardized classification or method to report and describe civilian war injuries and the injury panorama. Variations in how the injuries were reported made synthesis of the results difficult. In the present survey we haven’t investigated mortalities and causes of death. Reliable data from recent wars, such as the ongoing war in Ukraine and Gaza, was missing from the open literature. Conclusions The distribution of injuries seems comparable with data from World War II and the conflict in Korea. There is no standardized simple protocol to report civilian injuries in war. Ideally, a protocol should include even the severity impact of the injuries. Knowledge of civilian injury pattern and estimate of the total number of wounded is important to plan the civilian health care capabilities in war time.

Background: War causes severe suffering and harm to the civilian population. Knowledge about civilian injury patterns constitutes a part of the dimensioned planning and preparedness for medical care and civilian defence in times of war. This systematic review is conducted on request from The Swedish National Board of Health and Welfare and includes civilian injury patterns in modern war. Methods: The aim of the study is to describe civilian injury patterns in war 1973–2023. We have conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The protocol has been registered 2023-05-06 in PROSPERO (CRD4202321483). Results: The search resulted in 3455 identified articles. 1226 of those were duplicates. 2229 studies were assessed, and 1817 papers were excluded. 412 papers went through full text assessment resulting in 63 remaining papers. Injuries to the extremities constitutes 50%, followed by head injuries (26%) and injuries to the chest (18%). Notably, 23% of the wounded are children. Discussion: There is no standardized classification or method to report and describe civilian war injuries and the injury panorama. Variations in how the injuries were reported made synthesis of the results difficult. In the present survey we haven't investigated mortalities and causes of death. Reliable data from recent wars, such as the ongoing war in Ukraine and Gaza, was missing from the open literature. Conclusions: The distribution of injuries seems comparable with data from World War II and the conflict in Korea. There is no standardized simple protocol to report civilian injuries in war. Ideally, a protocol should include even the severity impact of the injuries. Knowledge of civilian injury pattern and estimate of the total number of wounded is important to plan the civilian health care capabilities in war time. [ABSTRACT FROM AUTHOR]

Background: The war in Ukraine has led to a strategic reorientation of the German Armed Forces towards national and alliance defense. This has also raised the need for medical and surgical adaptation to scenarios of conventional warfare. In order to develop appropriate and effective concepts it is necessary to identify those war injuries that are associated with a relevant primary and secondary mortality and that can be influenced by medical measures (potentially survivable injuries). Objective: The aim of this selective literature review was to identify war injuries with high primary and secondary mortality. Methods: A selective literature review was performed in the PubMed® database with the search terms war OR combat AND injury AND mortality from 2001 to 2023. Studies including data of war injuries and associated mortality were included. Results: A total of 33 studies were included in the analysis. Severe traumatic brain injury and thoracoabdominal hemorrhage were the main contributors to primary mortality. Injuries to the trunk, neck, traumatic brain injury, and burns were associated with relevant secondary mortality. Among potentially survivable injuries, thoracoabdominal hemorrhage accounted for the largest proportion. Prehospital blood transfusions and short transport times significantly reduced war-associated mortality. Conclusion: Control of thoracoabdominal hemorrhage has the highest potential to reduce mortality in modern warfare. Besides that, treatment of traumatic brain injury, burns and neck injuries has a high relevance in reducing mortality. Hospitals of the German Armed Forces need to focus on these requirements. [ABSTRACT FROM AUTHOR]

« Couteau-suisse » de la chirurgie reconstructrice, le lambeau de grand dorsal est de plus en plus délaissé au profit des lambeaux fasciocutanés. L'objectif de cette étude était d'analyser les modalités de réalisation de ce lambeau ainsi que l'évolution de ses indications afin de définir sa place actuelle en traumatologie. Quarante-quatre cas ont été recensés rétrospectivement de janvier 2000 à décembre 2020 au sein de l'HIA Percy, dont 37 cas de lambeaux libres, principalement réalisés pour des reconstructions de pertes de substance étendues avec exposition osseuse et/ou articulaire. Il était également réalisé dans 10,8 % des cas en sauvetage après échec d'une autre solution de reconstruction. Cette analyse a permis de confirmer l'intérêt du lambeau de grand dorsal dans le cas de pertes de substances délabrantes du membre inférieur, mais également chez le grand brûlé, à des fins de réhabilitation fonctionnelle ou de couverture, afin de permettre une rééducation précoce. Reconstructive surgery's workhorse, the latissimus dorsi flap is increasingly abandoned in favour of fasciocutaneous flaps. The purpose of this study was to analyse the methods used to perform this flap and the evolution of its indications in order to define its current place in traumatology. Forty-four cases were recorded retrospectively from January 2000 to December 2020 at HIA Percy, including 37 cases of free flaps, mainly performed for reconstruction of extensive loss of substance with bone and/or joint exposure. It was also performed in 10.8% of cases for salvage after failure of an alternative reconstruction solution. This analysis confirms the value of the latissimus dorsi flap in cases of significant substance loss in the lower limb, but also in burn patients for functional rehabilitation or to allow early rehabilitation. [ABSTRACT FROM AUTHOR]

BackgroundArmed conflict injury is a growing public health concern, particularly in regions like the Middle East and North Africa (MENA). The protracted conflicts and political unrest in this region have led to a substantial number of injuries. Despite this, there is still limited understanding of the specific injury patterns stemming from conflicts, such as the 2006 Lebanon conflict. This study aimed to assess the characteristics and burdens of injuries resulting from this conflict, which occurred 16 years prior to this research.MethodsThis retrospective study analyzed data of individuals affected by the 2006 Lebanon conflict, across three tertiary care centers. Demographics, injuries, complications, injury management, and hospitalization expenses were extracted from medical records and analyzed using SPSS version 29.0. Categorical variables were presented as counts and proportions, and continuous variables as mean ± standard deviation (SD). Hospital comparisons utilized chi-square or Fisher’s exact tests for categorical variables, and one-way ANOVAs for continuous variables. Analysis was conducted from September to November 2023.ResultsAcross three hospitals, 341 patients were studied, comprising 73.6% males and 26.4% females. Among them, a notable proportion (57.3% males and 34.1% females) fell within the 18–39 age range. Children and adolescents under 18 years accounted for 15.9% of males and 25.9% of females. Blast-related injuries predominated, with 24.5% resulting from direct damage caused by explosive parts and 33.3% from blast wave forces. Extremity trauma occurred in 49.0% of patients, and head/neck trauma in 24.9%. Common injuries, including penetrating, musculoskeletal, and traumatic brain injuries affected 34.9%, 31.1, and 10.0% of patients, respectively. Wound repair, fracture treatment, and debridement were the most performed procedures on 15.5, 13.5 and 9.7% of the patients, respectively. The total cost of care was USD 692,711, largely covered by the Ministry of Public Health (95.9%).ConclusionConflict-related injuries significantly contribute to the global burden of disease. Therefore, there is a pressing need to improve national guidelines to prioritize life-threatening cases and potential long-term disabilities. Furthermore, enhancing electronic registry systems to collect clinical data on injured patients is essential for conducting research and better understanding the needs of conflict casualties.

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Background: Afghanistan has been plagued by war for more than 30 years, but little is known about the civilian cost of such a long-lasting conflict. In particular, the incidence of war injuries among civilians has largely been under-reported. EMERGENCY NGO's Surgical Centre for War Victims has been operating in Kabul since 2001, providing care free of charge to anyone injured in war. The primary aim of our study is to describe the population of patients admitted to our hospital in Kabul. Methods: This is a 5-year retrospective analysis of all recorded hospital admissions at EMERGENCY NGO's hospital in Kabul, Afghanistan, from 1 January 2017 to 31 December 2021. Results: During the study period, 16,053 patients were admitted. Of these, 85.7% were male and 17.5% were under 14 years old. The proportion of male patients increased progressively with the age ranges (from 63.4 to 89.0%). Bullet wounds were the most frequent kind of injury (55.6%), followed by shell, stab and mine wounds (32.2%, 8.3% and 3.9% respectively). Only 5.8% of patients arrived at our hospital within the "golden hour" following injury. No significant reduction in the hospitalization trend was observed over the study period. The overall in-hospital mortality rate was 4.41%, which bore no correlation to the number of admissions. Conclusions: This study provides for the first time epidemiology of war-related injuries in a hospital located in a place of long-standing conflict. [ABSTRACT FROM AUTHOR]

Abstract Background During the Syrian civil war, patients were initially treated on-site in Syria and later transferred to medical centers in Israel. Relevant details concerning the exact nature of injury and medical/surgical care received in Syria were unavailable to clinicians in Israel. Many of these patients required abdominal re-exploration for obvious or suspected problems related to their injury. Our aim is to present our approach to abdominal trauma patients who survived initial on-site surgery and needed subsequent abdominal re-exploration abroad, in our medical center. Methods Clinical data from all medical records were retrospectively analyzed. Each patient underwent total body computerized tomography on arrival, revealing diverse multi-organ trauma. We divided the patient population who had abdominal trauma into 4 sub-groups according to the location in which abdominal surgical intervention was performed (abdominal surgery performed only in Syria, surgery in Syria and subsequent re-laparotomy in Israel, abdominal surgery only in Israel, and management of patients without abdominal surgical intervention). We focused on missed injuries and post-operative complications in the re-laparotomy sub-group. Results By July 2018, 1331 trauma patients had been admitted to our hospital, of whom 236 had suffered abdominal trauma. Life-saving abdominal intervention was performed in 138 patients in Syria before arrival to our medical center. A total of 79 patients underwent abdominal surgery in Israel, of whom 46 (33%) required re-laparotomy. The absence of any communication between the surgical teams across the border markedly affected our medical approach. Indications for re-exploration included severe peritoneal inflammation, neglected or overlooked abdominal foreign bodies, hemodynamic instability and intestinal fistula. Mortality occurred in 37/236 patients, with severe abdominal trauma as the main cause of fatality in 10 of them (4.2%), usually following urgent re-laparotomy. Conclusions Lack of information about the circumstances of injury in an environment of catastrophe in Syria at the time and the absence of professional communication between the surgical teams across the border markedly dictated our medical approach. Our concerns were that some patients looked deceptively stable while others had potentially hidden injuries. We had no information on who had had definitive versus damage control surgery in Syria. The fact that re-operation was not performed by the same team responsible for initial abdominal intervention also posed major diagnostic challenges and warranted increased clinical suspicion and a change in our standard medical approach.

War's nature is constantly changing over time with the progress in military technology and weapons of war, which has led to a diverse pattern of tissue injuries. Developments in personal protective equipment and body armor, rapid transfer from the battlefield to medical centers, improved resuscitation measures, bleeding control, and wound management have increasingly contributed to the wounded survival. However, the injured suffer tissue injuries of various degrees, thereby undergoing complicated and prolonged treatments. An increasing incidence of injuries caused by explosive devices in modern wars has more complicated treatment and recovery of the injured, highlighting the need for modern treatment methods based on stem cells in military medicine. Stem cells can be harvested from various sources such as bone marrow, adipose tissue, skeletal muscle, skin, umbilical cord blood and Wharton's jelly, placenta and amniotic fluid, and with the ability of self-renewal, proliferation, and differentiation into functional cells of different tissues, anti-inflammatory, paracrine and immune system modulating activities have been considered as a promising therapeutic approach to many battlefield injuries and their complications. Recent research in this area reveals the development of solutions to reduce critical consequences when facing the injuries caused by warfare. Thereby, in this review, in addition to outlining the most important tissue injuries in modern combat, recent developments in the use of stem cells for the regeneration of injured tissues have been highlighted. [ABSTRACT FROM AUTHOR]

Abstract Background The current Libyan civil war has originated many casualties, imposing medical challenges. War injuries are complex, requiring specialized knowledge and interdisciplinary assessment for adequate patient and intercultural management. Methods This retrospective study analyzed records of 78 Libyan patients admitted from July 2016 to November 2017 to neurological and trauma surgical departments of Krankenhaus Nordwest, Frankfurt, Germany. Issues of system preparation of the hospital, demographics, injury patterns and therapies were analyzed. The chi-squared test was used to analyze differences in injury patterns in explosion and gunshot injuries. Results Seventy-seven of seventy-eight patients were male (mean age 30.6 years). The patients received primary and secondary treatment in Tunisia (n = 39), Libya (n = 36) and Turkey (n = 23). Forty-eight patients had gunshot injuries, 37 explosion injuries, 11 both. Preparation for management of injuries included hygienic and isolation protocols, organization of interpreters and intercultural training. Patients presented with a broad variety of neurological, psychiatric and trauma surgical injuries. Fifty-six patients had sensory, 47 motor deficits. Nine reported headache, 5 vertigo, 13 visual impairment, 28 psychiatric symptoms. Eighteen patients had central nervous damage, 50 peripheral nervous damage. Central nervous damage was significantly more common in gunshot than explosion injuries (p = 0.015). Peripheral nervous damage was more common in explosion than gunshot injuries (p

Background: During the Syrian civil war, patients were initially treated on-site in Syria and later transferred to medical centers in Israel. Relevant details concerning the exact nature of injury and medical/surgical care received in Syria were unavailable to clinicians in Israel. Many of these patients required abdominal re-exploration for obvious or suspected problems related to their injury. Our aim is to present our approach to abdominal trauma patients who survived initial on-site surgery and needed subsequent abdominal re-exploration abroad, in our medical center.Methods: Clinical data from all medical records were retrospectively analyzed. Each patient underwent total body computerized tomography on arrival, revealing diverse multi-organ trauma. We divided the patient population who had abdominal trauma into 4 sub-groups according to the location in which abdominal surgical intervention was performed (abdominal surgery performed only in Syria, surgery in Syria and subsequent re-laparotomy in Israel, abdominal surgery only in Israel, and management of patients without abdominal surgical intervention). We focused on missed injuries and post-operative complications in the re-laparotomy sub-group.Results: By July 2018, 1331 trauma patients had been admitted to our hospital, of whom 236 had suffered abdominal trauma. Life-saving abdominal intervention was performed in 138 patients in Syria before arrival to our medical center. A total of 79 patients underwent abdominal surgery in Israel, of whom 46 (33%) required re-laparotomy. The absence of any communication between the surgical teams across the border markedly affected our medical approach. Indications for re-exploration included severe peritoneal inflammation, neglected or overlooked abdominal foreign bodies, hemodynamic instability and intestinal fistula. Mortality occurred in 37/236 patients, with severe abdominal trauma as the main cause of fatality in 10 of them (4.2%), usually following urgent re-laparotomy.Conclusions: Lack of information about the circumstances of injury in an environment of catastrophe in Syria at the time and the absence of professional communication between the surgical teams across the border markedly dictated our medical approach. Our concerns were that some patients looked deceptively stable while others had potentially hidden injuries. We had no information on who had had definitive versus damage control surgery in Syria. The fact that re-operation was not performed by the same team responsible for initial abdominal intervention also posed major diagnostic challenges and warranted increased clinical suspicion and a change in our standard medical approach. [ABSTRACT FROM AUTHOR]

During the reconstruction of the cellars of a house in Staňkova Street in Brno (Czech Republic), the human skeletal remains of 12 individuals stored in a common grave pit were discovered. By its arrangement, this grave corresponded to mass burials during war conflicts, epidemics or famines. Using the radiocarbon method, the skeletons were dated to the early nineteenth century, when the Napoleonic Wars took place in Central Europe. A detailed analysis of the osteological collection revealed that young men aged from 20 to 30 years, with an average body height of 167.6 cm, were buried in the grave. On one of the skeletons, a comminuted fracture of the humerus was recorded, probably caused by a gunshot wound; on another, there were visible traces of a surgical procedure — amputation. From the results of the examination, it is possible to assume that these were soldiers who had died in a temporary field hospital. The hypothesis was confirmed by the analysis of dental calculus, in which traces of sulphur and nitrogen were found, which are components of gunpowder. Degenerative changes in the spine and bones of the lower limbs also indicate a huge physical strain when carrying heavy weapons during long marches in heavy military footwear. Genetic determination of the mitochondrial DNA haplogroups revealed three different haplogroups that occur with different frequencies in different parts of Europe. So it is probable that victims of the Battle of the Three Emperors, which took place in nearby Austerlitz (Slavkov u Brna) on 2 December 1805, were buried in the mass grave under study. [ABSTRACT FROM AUTHOR]

Introduction Critical care nurses must maintain optimal work performance. Fatigue and sleep disturbance can limit safe practice and cause negative patient outcomes. This study aimed to explore fatigue and sleep quality among critical care nurses in the war zone in Najran City, Saudi Arabia. Methods A cross-sectional research design was used and a convenience sample was applied to include 352 nurses working in critical units at various hospitals in Najran City, Saudi Arabia. A self-administered questionnaire containing three parts was used: demographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), and the Fatigue Severity Scale (FSS). Results The study revealed that 232 nurses (65.9%) reported poor sleep quality. Regarding fatigue levels, 89 nurses (25.2%) reported severe fatigue and 113 (32.1%) reported moderate fatigue. Notably, caring for war-related injuries exhibited a significant positive correlation (r = 0.62, p = 0.0001). Experience correlated negatively (r = -0.47, p = 0.003) with sleep quality and fatigue scores. Most significantly, involvement in caring for war-related injuries showed a strong positive correlation (r = 0.71, p = 0.00001) with FSS scores. Conclusions Poor sleep quality was significantly widespread among the studied nurses. The results indicated that about one-quarter of the studied nurses reported severe fatigue, which was alarmingly prevalent among nurses. Nurses involved in caring for war-related injuries exhibited a strong positive correlation with both PSQI and FSS scores. Recommendations The authors recommend developing and implementing counseling and stress management programs to address the unique challenges faced by nurses caring for war-related injuries., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee of Najran University issued approval 441-440-9722-DS. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ramadan Elrefaey et al.)

Abstract Background War-related injury is a major public health concern, and a leading cause of mortality, morbidity, and disability globally, particularly in low and middle-income countries such as Palestine. Little is known about the burden of war-related injury in the Palestinian context. The objective of this study was to characterize the incidence and pattern of injuries, associated with war in Gaza Strip, from July 8 to August 26, 2014. Methods This was a descriptive study based on an injury registry at hospital facilities in the Gaza Strip. A total of 420 victims records from 2014 Gaza war injuries were randomly selected, proportionate to the size of the study population estimated across five Gaza governorates. Simple descriptive statistics were calculated to explore the frequency and percentage distribution of study variables and injury data. A chi-square test (X2) was used. The significance level was derived at p

Background Extremity vascular injuries represent 50–70% of all injuries treated during wars. Hence, our objectives are to elaborate the challenges of vascular war injuries and to clarify their mechanisms, pattern, effectiveness of management and outcomes during war in Jazan. Patients and methods This is a descriptive study of patients with war-related vascular injuries treated in King Fahd Teaching Hospital during the war in Jazan (Saudi Arabia) from February 2016 to May 2016. The study included age, mechanism of injury, site of vascular injury, pattern of repair, and clinical outcome. Results This study included 56 patients with a mean age of 37 years. All patients were men (100%); four (7.1%) patients were civilians; 23 (41%) patients presented with blast injuries; and 33 (59%) patients presented with gunshot injuries. There were 40 (71.4%) arterial injuries, 16 (28.6%) venous injuries, and seven combined injuries (arterial and venous). Repair was done in 37 patients and ligation in 19 patients. Primary amputation was done in eight patients and secondary amputation in one patient. Conclusion Management of vascular injuries during wars presents a unique challenge to surgeons; standard vascular technical repair remains the gold standard management in vitally stable patients; primary extremity amputation is a lifesaving procedure in unstable patients with other life-threatening injuries. [ABSTRACT FROM AUTHOR]

Abstract The dynamic nature of modern warfare, including threats and injuries faced by soldiers, necessitates the development of countermeasures that address a wide variety of injuries. Tissue engineering has emerged as a field with the potential to provide contemporary solutions. In this review, discussions focus on the applications of stem cells in tissue engineering to address health risks frequently faced by combatants at war. Human development depends intimately on stem cells, the mysterious precursor to every kind of cell in the body that, with proper instruction, can grow and differentiate into any new tissue or organ. Recent reports have suggested the greater therapeutic effects of the anti-inflammatory, trophic, paracrine and immune-modulatory functions associated with these cells, which induce them to restore normal healing and tissue regeneration by modulating immune reactions, regulating inflammation, and suppressing fibrosis. Therefore, the use of stem cells holds significant promise for the treatment of many battlefield injuries and their complications. These applications include the treatment of injuries to the skin, sensory organs, nervous system tissues, the musculoskeletal system, circulatory/pulmonary tissues and genitals/testicles and of acute radiation syndrome and the development of novel biosensors. The new research developments in these areas suggest that solutions are being developed to reduce critical consequences of wounds and exposures suffered in warfare. Current military applications of stem cell-based therapies are already saving the lives of soldiers who would have died in previous conflicts. Injuries that would have resulted in deaths previously now result in wounds today; similarly, today’s permanent wounds may be reduced to tomorrow’s bad memories with further advances in stem cell-based therapies.

The Iraq–Iran war (1980–88) resulted in numerous maxillofacial injuries. More than 400,000 people were wounded and required specialist care. Paul Tessier, a leading French plastic surgeon and pioneering craniofacial surgeon, was involved in several missions to Iran and operated on a vast cohort of patients with complex war trauma sequelae. Our study included 322 files relating to patients with war injuries operated on by Paul Tessier in Iran from 1990 to 1993. The files were the property of the Association Française des Chirurgiens de la Face. Relevant epidemiological parameters and data on surgical indications and procedures were collected. Descriptive statistics were used in order to characterize the cohort, and a multivariate logistic model was developed in order to assess factors associated with severe eye injuries within all facial injuries. Age range at admission was 5–67 years (average: 27.15 ± 6.97). The most common trauma mechanisms were shell fragments (161 patients; 50 %) and bullets (27 patients; 8.38 %). The bone and orbital contents in the upper third of the face were affected in 124 patients (38.50%); 72 patients (22.36%) had trauma of the middle third of the face; and 86 patients (26.71%) had trauma of the lower third. A total of 175 bone grafts were harvested by Tessier: 72 (41.14%) iliac grafts and 94 (53.71%) frontal and/or parietal grafts. Tessier managed 60 orbital fractures (18.63%) and 95 patients with uni- or bilateral enucleations (29.50%). A multivariate logistic model showed that patients injured by shells were 4.04 (1.32; 17.60) more likely (p = 0.03) than patients with gunshot wounds to have had uni- or bilateral enucleation, regardless of age and gender. Tessier's files provide first-hand information on the injury patterns that resulted from a regional war in the 1980s, and on the reconstruction challenges faced by a country during its post-war recovery period. [ABSTRACT FROM AUTHOR]

Combat wounds can be difficult to manage and can lead to disfigurement and infection. The closure of these wounds is crucial, as delayed closure also increases the risk of further complications. Military medicine has introduced negative pressure wound therapy, which modulates wounds perfectly through the microscopic and macroscopic configurations of the wound environment. It is expensive and not available worldwide, and several modifications using low cast materials were mentioned in literature. We present a case series of four patients using the previously mentioned modified technique in combat wound management, and discuss the results, outcome, and justification for choosing this modality of treatment. All patients underwent a thorough debridement, followed by a modified negative pressure wound treatment for three weeks, employing readily available medical devices. All wounds healed successfully without complication and a simple closure was used to cover the resultant wound. Modified NPWT with limited resources is capable of promoting healing in conflict-related wounds through multifactorial properties and transforming reconstructive methods from complex to simple procedures in areas with a shortage of medical supplies and surgeons in addition to busy operating rooms. • Combat injuries are destructive and wound at high risk of infection and delayed reconstruction is advisable but open wound pose significant morbidities. • Negative pressure wound therapy was used since decades and proved it's effectiveness, but high cost and shortage of materials are drawbacks so modification was created to obtained advantages of NPWT with low case limited resources. • Modified NPWT can be uesd in military medicine and it provided optimal condition for wound healing. [ABSTRACT FROM AUTHOR]

Purpose: Is to compare the patterns, severity, and management of the high- and low-velocity mandibular war injuries managed at Al Shaheed Gazi Al-Hariri Hospital in Baghdad Medical City, Iraq, during a 2-year period.Methods: Forty-one patients with a history of mandibular war injuries treated by our maxillofacial team were reviewed during a period of 2 years (2015-2017). All patients were treated in the Maxillofacial Unit of the Hospital of Specialized Surgeries in Baghdad Medical City.Results: A 2-year retrospective study evaluated 41 patients with mandibular war injuries with a total of 94 fractures (comminution represents 79.06% of the bullet injuries, while it is only 62.74% with IED injuries). Management of these injuries was varied according to the severity of the injuries and resources available. Close reduction was used in 72.72% of the linear fracture cases, whereas open technique was used in 56.6% of the comminuted fractures.Conclusions: Bullet injuries were associated with a higher number of mandibular comminuted fractures, in addition to more extensive bone loss. While shell injuries of IED (improvised explosive devices), on the other hand, were associated with higher infection rate and more postoperative complication. [ABSTRACT FROM AUTHOR]

• Limb reconstruction of severe neglected war injuries can avoid amputation. • Single stage treatment is possible with only one day postoperative hospital stay. • Corticotomy first technique, conservative debridement of infection and osteoplastic procedures can be done together. • Postoperative gradual reduction of bone ends is possible without anaesthesia. War injuries are remarkably different situations with profound severity and significant contamination compared to civilian injuries. Delayed definitive management makes the situation much more complicated. This study aimed to report the outcomes of limb reconstruction of neglected war injuries with a previous decision of amputation. From 2010 to 2021, 1104 patients with war-related fractures from conflict-zone countries were referred to our center including 589 open tibial fractures. Of these tibial fractures, amputation had already been decided in 54 cases, and the patients were looking for a trial of reconstruction and avoiding amputation. These cases were included in the current study. The treatment approach was a single-stage procedure with bone and soft tissue reconstruction. This study included 54 male patients with a mean age of 26.3 years. Infection was the predominant feature in 43 cases (79.6 %). CT angiography revealed a one-vessel limb in 17 patients. Peripheral nerve injuries affected 15 patients. The mean time from injury to presentation was 8.5 weeks. The bone gap (2–13 cm) was evident in 44 cases. In four cases, the contralateral limb was amputated below the knee. There were associated injuries in nine cases. Rotational flap coverage was done in the same setting for 19 legs. Gastrocnemius flap was done in two cases. The mean follow-up duration was 45.1 months. The treatment methods included bifocal management (33 cases), trifocal management (17 cases), fibular transfer (two cases), and a mono-focal approach in two cases. All fractures healed successfully. The mean external fixation period was 7.6 months. Recurrence of infection occurred in three patients. A non-displaced refracture developed in one case. Five cases had a residual angular deformity. Eventually, the ASAMI bone and functional results were good in all cases. Neglected war injuries constitute a complex problem where amputation may be indicated. Our approach includes one-stage limb reconstruction with the corticotomy-first technique, conservative debridement of the docking site, concomitant osteoplastic procedure, and gradual distraction to tackle all the aspects of the problem. The good results obtained in the presented series make it a valid approach to avoid amputation in neglected war injuries. [ABSTRACT FROM AUTHOR]

Background: A large number of innocent Syrians were injured or killed during the years of war. This retrospective study investigates the differences in patterns of injury and factors affecting the mortality rate in 324 patients coming to Damascus Hospital with penetrating abdominal trauma, and illustrates the difficulties of diagnosis and decision making in crisis situations.Methods: A retrospective study was registered from patient's records between October 2012 and June 2013 in Damascus Hospital. All victims were injured either by explosions or gunshots.Results: A total of 325 patients: 183 by explosion; 56.3%, 141 by gunshot; 43.3%, and one patient by other means; 0.3% were reviewed. The study focused on the two large groups with a total of 324 patients. Males were predominant (82.1%; n=266) and the majority of patients were between 19 and 35 years old. Patients suffering from multi abdominal organ injury were more common in gunshot group (n=72, 51.1%) compared to the explosion group (n=83, 45.3%). 264 patients (81.5%) underwent surgical operations and only 22 (8.3%) had normal laparotomy. The inpatient mortality rate was (17.0%; n=55), and there was no difference in mortality rate between the two groups. More than the half of deaths (n=42; 76.4%) had a P.A.T.I score≥25 where the death rate was 35.6% which is higher compared to 6.3% in those with a P.A.T.I<25. In the ICU 33 patients died, of these (87.9%; n=29) died after immediate admission to the ICU which is higher compared with a later admission (12.1%; n=4). The need for massive blood transfusion affected the mortality rate.Conclusion: Efforts must be directed toward training of medical staff to deal with crisis incidents. The need for massive blood transfusion and ICU admissions can affects mortality. P.A.T.I was found to be an effective predictor of mortality. Clinical experience in this field can produce better health care and faster judgments. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury associated coagulopathy is frequent, either in isolated traumatic brain injury in civilian practice and in combat traumatic brain injury. In war zone, it is a matter of concern because head and neck are the second most frequent site of wartime casualty burden. Data focusing on transfusion requirements in patients with war related TBI coagulopathy are limited.Materials and Methods: A descriptive analysis was conducted of 77 penetrating traumatic brain injuries referred to a French role 3 medical treatment facility in Kabul, Afghanistan, deployed on the Kabul International Airport (KaIA), over a 30 months period.Results: On 77 patients, 23 died during the prehospital phase and were not included in the study. Severe traumatic brain injury represented 50% of patients. Explosions were the most common injury mechanism. Extracranial injuries were present in 72% of patients. Traumatic brain injury coagulopathy was diagnosed in 67% of patients at role 3 admission. Red blood cell units (RBCu) were transfused in 39 (72%) patients, French lyophilized plasma (FLYP) in 41 (76%), and fresh whole blood (FWB) in 17 (31%).Conclusion: The results of this study support previous observations of coagulopathy as a frequent complication of traumatic brain injury. The majority of patients with war related penetrating traumatic brain injury presented with extracranial lesions. Most of them required a high level of transfusion capacity. [ABSTRACT FROM AUTHOR]

• Applying lessons from humanitarian medical aid missions improves preparedness for future crises. • Between 2013–2018, Israel provided treatment to trauma patients injured in neighboring warzones during the Syrian Civil War. • We cross-referenced two registries documenting prehospital and in-hospital care of these patients within Israel (n = 856). • Most patients suffered from blast (62.1%) or gunshot (28.2%) injuries and 40.1% required intensive care unit admission. • This study highlights the injury patterns and resource allocation expected in caring for neighboring warzone casualties. Warzone humanitarian medical aid missions are infrequent and applying lessons from these missions is vital to ensuring preparedness for future crises. Between 2013–2018, the Israel Defense Forces Medical Corps (IDF-MC) provided humanitarian medical aid to individuals injured in the Syrian Civil War who chose to seek medical assistance at the Israeli-Syrian border. Patients requiring care surgical or advanced care were transferred to civilian medical centers within Israel. This study aims to describe the injury characteristics and management of hospitalized Syrian Civil War trauma patients over a five-year period. Retrospective cohort analysis cross-referencing data from the IDF trauma registry, documenting prehospital care, and the Israel National Trauma Registry, documenting in-hospital care, between 2013 and 2018. Syrian trauma patients hospitalized in Israeli hospitals were cross-referenced between the two registries. Multivariable logistic regression was applied to identify independent factors associated with in-hospital mortality. Overall, 856 hospitalized trauma patients were included following definitive cross-matching. The median age was 23 years, and 93.3% were males. Blast (n = 532; 62.1%) and gunshot (n = 241; 28.2%) were the most common injury mechanisms. Injury Severity Score was ≥25 for 28.8% of patients and most common body regions with severe injury (Abbreviated Injury Scale≥3) were the head (30.7%) and thorax (25.0%). Intensive care unit admission was required for 40.1% of patients, and the median hospital stay was 13 days. In-hospital mortality was recorded for 73 (8.5%). Signs of shock upon emergency department admission and severe head injury were significantly associated with mortality in the adjusted model whereas age of <18 years was associated with decreased odds for in-hospital mortality. Trauma patients hospitalized in Israel following injuries sustained in the Syrian Civil War were characterized by a high prevalence of blast injuries with concomitant involvement of several body regions. Future missions should ensure preparedness for complex multi-trauma, often involving the head, and ensure high intensive care and surgical capacities. [ABSTRACT FROM AUTHOR]

In the period from September 10th 1991 to December 31st 1992, the total of 162 patients with penetrating craniocerebral war injuries from the former Yugoslavia battlefields were treated in the Military Medical Academy (MMA) in Belgrade. The severity of injury was graded according to the Glasgow Coma Score (GCS) as mild (13-15), moderate (9-12), and severe (3-8). The extensity of the cerebral lesion was classified as unilobar, multilobar, bihemispheric, transventricular, and haematoma with shift. Injuries were divided into those caused by bullets or shrapnel. According to the missile path, these were tangential, uncrossed, and crossed injuries. The patients were divided into the two groups according to the treatment that they received: Group A- 90 patients who were referred directly to the MMA without surgical treatment, and group B-72 patients who were treated surgically (minimal debridment or simple wound closure) in the local hospitals before the evacuation to the MMA. The outcome was assessed on the discharge from the MMA according to the Glasgow Outcome Scale (GOS). Severe penetrating injuries had poor outcome as compared to moderate and mild injuries (p=0.001). Multilobar and bihemispheric injuries as compared to unilobar, and crossing as compared to uncrossing or tangential injuries had a poor outcome (p=0.001). Bullet injuries had a poor outcome then shrapnel injuries (p=0.016). For the treatment of the complications or additional debridement 6.5% patients from the group A and 78% from the group B were reoperated. There was no statistically significant difference regarding the final outcome of the patients from the group A comparing to the group B (p = 0.169). Severity of the injury, extensity of the cerebral lesion, the missile path, and the type of missile significantly influenced the final outcome. Minimal debridement of penetrating gunshot injuries was not a sufficient solution because it required a high rate of reoperation in the later stage.

This essay gives general ideas about medical knowledge during the First World War. It reveals those changes in treatment of different types of injuries that appeared as a result of war experiences. Significant progress was noticeable in medical science concerning wound care and in modes of treatment of belly, chest, cranial bone and joints. Important knowledge was gained in prevention and care of infectious diseases and diagnosis, description and care in complex war conditions. [ABSTRACT FROM AUTHOR]

Backgrounds: The NATO KAIA Hospital (Kabul International Airport), under French command, provided medical support for NATO forces in the Kabul region from 2009 to 2014. Medical assistance to civilians was an additional mission which included support for children who were war injured. The objective of this study was to analyze characteristics of cephalic injuries in children victims of war trauma.Methods: A retrospective study was conducted and commenced with the hospital opening (July 2009) to March 2012 on all children (<15years) with war trauma. We distinguished cephalic lesions in cranial (neuro-surgical), ophthalmological and neck regions. We analyzed mechanism, region, severity score, surgeries and resuscitation efforts.Results: 217 children were operated on with 81 war traumas (mean age 10.2years). 36 children (44.4%) had a cephalic injury. 52.9% of the injured had an ophthalmological injury, 38.2% a cranial region injury and 29.4% a neck lesion. Mortality rate was 5.6% (1 hemorrhagic shock and 1 cerebral wound) in this cephalic lesion group. Ophthalmic injuries were the most common of cephalic injuries; 19 children of which 7 had a bilateral injury (26 eyes). In this group, fragmentary injuries were the most frequent (64% of eyes). In cerebral lesion group, the lesions were linked to a bullet or a shrapnel in 9 of 13 children. This mechanism systematically caused a crania-cerebral wound. Explosion (fragmentary and shrapnel) was the most important in the neck lesions (7 children of 10).Conclusions: The cephalic lesions were the second most common region in children during our experience in Afghanistan. Lack of protection (helmet) in children may explain the frequency of cephalic wounds. [ABSTRACT FROM AUTHOR]