Characteristics of Improvised Explosive Device Trauma Casualties in the Gaza Strip and Other Combat Regions: The Israeli Experience.

OBJECTIVE: Low-intensity conflict is characterized in asymmetrical conventional and nonconventional warfare. The use of improvised explosive devices (IEDs) in the Israeli-Palestinian conflict has evolved over the past few decades to include the addition of diesel, biological agents, shrapnel, and nitroglycerin to the explosive content. Due to its nature and mechanism, an IED injury might present as a multidimensional injury, impairing numerous systems and organs. MATERIALS AND METHODS: The authors present a case series of 5 Israeli Defense Forces (IDF) soldiers wounded by an IED presenting a typical and similar pattern of burns to their faces, trunks, and limbs, in addition to ocular, ear/nose/throat, and orthopedic injuries. An analysis of the experience in treating the aforementioned injuries is included. RESULTS: Improvement in casualties' burns and traumatic tattoos was observed following debridement, aggressive scrubbing with or without dermabrasion, and conservative local dressing treatment protocol. The authors found a positive correlation between improvement degree and treatment timing. Injury pattern was correlative to the protective gear worn by the soldiers. Wearing protective eye gear and wearing ceramic vests can diminish the extent of IED injuries, while creating typical patterns of injuries to be treated. CONCLUSION: Based on these experiences, such injuries should be brought to a trauma center as soon as possible. Treating multidimensional trauma should be done in a facility with abilities to treat head injuries, eye injuries, penetrating injuries, blast injuries, and burns. Such specialized disciplines and facilities that have past experience with IEDs and war injuries are able to assess and treat these injuries in a more dedicated manner, resulting in better long-term rehabilitation.

Reconstruction of a lower eyelid defect with a V to Y island flap.

Repair of full thickness defects in the lower eyelid following extirpation of malignant tumors presents a challenge to the reconstructive surgeon. There are several techniques to choose from, depending on the defect's size and location.