ABSTRACT
Plastic surgical techniques were described in antiquity and the Middle Ages; however, the genesis of modern plastic surgery is in the early 20th century. The exigencies of trench warfare, combined with medical and technological advances at that time, enabled pioneers such as Sir Harold Gillies to establish what is now recognized as plastic and reconstructive surgery. The physicians of Germany, Russia, and the Ottoman Empire were faced with the same challenges; it is fascinating to consider parallel developments in these countries. A literature review was performed relating to the work of Esser, Lanz, Joseph, Morestin, and Filatov. Their original textbooks were reviewed. We describe the clinical, logistical, and psychological approaches to managing plastic surgical patients of these physicians and compare and contrast them to those of the Allies, identifying areas of influence such as Gillies' adoption of Filatov's tube pedicle flap.
ABSTRACT
BACKGROUND: The Royal Centre for Defence Medicine is located at University Hospitals Birmingham (UHB). Since 2001 all UK military casualties injured on active duty have been repatriated here for their initial treatment. This service evaluation was performed to quantify the work undertaken, with the aim of providing a snapshot of a year's military trauma work in order to inform the delivery of trauma care in both the military and civilian setting. METHODS: Military patients admitted with traumatic injuries over a 12-month period were identified and the hospital notes and electronic records reviewed. Data were collected focusing on three areas - the details of the injury, information about the in-patient admission, and surgical interventions performed. RESULTS: A total of 388 patients were used in the analysis. Median total length of stay was 10.5 days (IQR: 4-26, range: 0-137 days), and a median 6.0 days (IQR: 3.0-11.0, range: 1-49 days) was spent on intensive care by 125 patients. Surgical intervention was required for 278 (71.6%) patients, with a median of 2.0 operations (IQR: 1.0-4.0, range: 1-27) or 170 min (IQR: 90.0-570.0, range 20-4735 min) operating time per patient. 77% of these patients had their first procedure within 24h of arrival. Improvised explosives accounted for 50.5% of injuries seen. Spearman rank correlation between New Injury Severity Score with length of stay demonstrated significant correlation (p<0.001), with a coefficient of 0.640. A model predicting length of stay based on New Injury Severity Score was devised for patients with battle injuries. CONCLUSION: This report of 12 months work at UHB demonstrates the service commitment to these casualties, describing the burden of care and resource requirements for military trauma patients.
