Combat-related facial burns: analysis of strategic pitfalls.

PURPOSE: Burns constitute approximately 10% of all combat-related injuries to the head and neck region. We postulated that the combat environment presents unique challenges not commonly encountered among civilian injuries. The purpose of the present study was to determine the features commonly seen among combat facial burns that will result in therapeutic challenges and might contribute to undesired outcomes. MATERIALS AND METHODS: The present study was a retrospective study performed using a query of the Burn Registry at the US Army Institute of Surgical Research Burn Center for all active duty facial burn admissions from October 2001 to February 2011. The demographic data, total body surface area of the burn, facial region body surface area involvement, and dates of injury, first operation, and first facial operation were tabulated and compared. A subset analysis of severe facial burns, defined by a greater than 7% facial region body surface area, was performed with a thorough medical record review to determine the presence of associated injuries. RESULTS: Of all the military burn injuries, 67.1% (n = 558) involved the face. Of these, 81.3% (n = 454) were combat related. The combat facial burns had a mean total body surface area of 21.4% and a mean facial region body surface area of 3.2%. The interval from the date of the injury to the first operative encounter was 6.6 ± 0.8 days and was 19.8 ± 2.0 days to the first facial operation. A subset analysis of the severe facial burns revealed that the first facial operation and the definitive coverage operation was performed at 13.45 ± 2.6 days and 31.9 ± 4.1 days after the injury, respectively. The mortality rate for this subset of patients was 32% (n = 10), with a high rate of associated inhalational injuries (61%, n = 19), limb amputations (29%, n = 9), and facial allograft usage (48%, n = 15) and a mean facial autograft thickness of 10.5/1,000th in. CONCLUSIONS: Combat-related facial burns present multiple challenges, which can contribute to suboptimal long-term outcomes. These challenges include prolonged transport to the burn center, delayed initial intervention and definitive coverage, and a lack of available high-quality color-matched donor skin. These gaps all highlight the need for novel anti-inflammatory and skin replacement strategies to more adequately address these unique combat-related obstacles.

Non-battle craniomaxillofacial injuries from U.S. military operations.

INTRODUCTION: Non-battle injuries (NBIs) can be a source of significant resource utilization for the armed forces in a deployed setting. While the incidence and severity of craniomaxillofacial (CMF) battle injuries (BIs) have reportedly increased in the ongoing U.S. military conflicts in Iraq and Afghanistan, the prevalence and the nature of NBIs are not well described. MATERIAL AND METHODS: The Joint Theater Trauma Registry was queried from October 2001 to February 2011, covering Operations Enduring Freedom and Iraqi Freedom, for both NBIs and BIs to the CMF region. Patient demographics, injury severity score, mechanism and type of injury were included in the query. Using ICD-9 diagnosis codes, CMF injuries were classified according to type (wounds, fractures, burns, vascular injuries, and nerve injuries). Statistical analysis was performed for comparative analysis. RESULTS: NBIs constituted 24.3% of all patients with CMF injuries evacuated to a regional combat support hospital (CMF BIs 75.4%). These injuries were characterized by blunt trauma, most commonly motor vehicle collisions (37%), and falls (20%). As compared to CMF BIs, CMF NBIs resulted in less mortality (1.3% vs. 3.1%, p < 0.0001), fewer injuries per patient (1.87 vs. 2.26, p = 0.055), and a decreased severity score (ISS) (8.38 vs. 12.98, p < 0.0001). However, a significant percentage of CMF NBIs still required evacuation out of theater (27.8% of NBIs vs. 42.2% of BIs, p < 0.0001), depleting the combat strength of the deployed forces. CONCLUSIONS: CMF NBIs accounted for a substantial portion of total CMF injuries. Though characterized predominantly by blunt trauma with an overall better prognosis, its burden to the limited resources of a deployment can be significant. This descriptive study highlights the need to allocate appropriate resources for treatment of these injuries as well as strategies to reduce both its incidence and severity. LEVEL OF EVIDENCE: IV Prognostic.