Combat Ballistic Injuries to the Face

Abstract

Combat ballistic injuries to the face present complex challenges for military medical personnel, often involving multiple traumas that require immediate intervention to preserve life and function. This review explores the mechanisms of ballistic trauma, highlighting the unique injury patterns seen in modern conflicts like those in Iraq, Afghanistan, Syria, and Ukraine. Advances in protective gear have altered injury profiles, increasing the incidence of head, neck, and facial injuries. Early evacuation and definitive care are critical, though prolonged field care settings may require adapted surgical techniques due to resource constraints. The goals of surgical management focus on restoring form and function, with treatment strategies influenced by the severity of injuries and available medical resources. This article also discusses the long-term complications, such as infections, nerve injuries, and posttraumatic stress disorder, emphasizing the need for a multidisciplinary approach. The evolving nature of combat injuries underscores the importance of continuous surgical innovation and timely intervention to improve outcomes for soldiers suffering from ballistic facial trauma.

Keywords

combat ballistic injuries - craniomaxillofacial trauma - facial fractures - ballistic injuries

Note

USU-WRNMMC Surgery: The opinions or assertions contained herein are the private ones of the author/speaker and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government.

Publikationsverlauf

Artikel online veröffentlicht:
26. März 2025

• References

• 1 Gillies H. , & Millard DR. The Principles and Art of Plastic Surgery. Boston: Little Brown; 1957
• 2 Gabriel RA. Between Flesh and Steel: A History of Military Medicine from the Middle Ages to the War in Afghanistan. Washington, DC: Potomac Books; 2013
• 3 Mabry RL, Holcomb JB, Baker AM. et al. United States army rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma 2000; 49 (03) 515-528 , discussion 528–529
• 4 Dye JL, Eskridge SL, Tepe V, Clouser MC, Galarneau M. Characterization and comparison of combat-related injuries in women during OIF and OEF. Mil Med 2016; 181 (01) 92-98
• 5 Sauer SW, Robinson JB, Smith MP. et al. Saving lives on the battlefield (part II) - one year later: a joint theater trauma system and joint trauma system review of prehospital trauma care in combined joint operations area-Afghanistan (CJOA-A). J Spec Oper Med 2015; 15 (02) 25-41
• 6 Mabry RL, DeLorenzo R. Challenges to improving combat casualty survival on the battlefield. Mil Med 2014; 179 (05) 477-482
• 7 Wade AL, Dye JL, Mohrle CR, Galarneau MR. Head, face, and neck injuries during Operation Iraqi Freedom II: results from the US Navy-Marine Corps Combat Trauma Registry. J Trauma 2007; 63 (04) 836-840
• 8 Owens BD, Kragh Jr JF, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma 2008; 64 (02) 295-299
• 9 Lanigan A, Lindsey B, Maturo S, Brennan J, Laury A. The Joint Facial and Invasive Neck Trauma (J-FAINT) project, Iraq and Afghanistan: 2011-2016. Otolaryngol Head Neck Surg 2017; 157 (04) 602-607
• 10 Ucak M. Shrapnel injuries on regions of head and neck in Syrian War. J Craniofac Surg 2020; 31 (05) 1191-1195
• 11 Ashworth E, Baxter D, Gibb CI, Wilson M, Bull AMJ. Injuries in fatalities of dismounted blast: identification of four mechanisms of head and spine injury. J Neurotrauma 2024; 41 (13–14): e1678-e1684
• 12 Palyvoda R, Olexandr K, Yan V. et al. Maxillofacial surgery in ukraine during a war: challenges and perspectives-a national survey. Mil Med 2024; 189 (9–10): 1968-1975
• 13 Sinyuk M, Polishchuk V, Yuschak P, Burachok I. Management of war-related facial wounds in Ukraine: the Lviv military hospital experience. BMJ Mil Health 2023; ( e-pub ahead of print).
• 14 Farber SJ, Kantar RS, Rodriguez ED. Facial trauma care in the austere environment. J Spec Oper Med 2018; 18 (03) 62-66
• 15 Salinas NL, Faulkner JA. Facial trauma in Operation Iraqi Freedom casualties: an outcomes study of patients treated from April 2006 through October 2006. J Craniofac Surg 2010; 21 (04) 967-970
• 16 Shin EH, Sabino JM, Nanos III GP, Valerio IL. Ballistic trauma: lessons learned from iraq and Afghanistan. Semin Plast Surg 2015; 29 (01) 10-19
• 17 Jeyaraj P. Cranial vault defects and deformities resulting from combat-related gunshot, blast and splinter injuries: how best to deal with them. J Maxillofac Oral Surg 2020; 19 (02) 184-207
• 18 Roeder RA, Schulman CI. An overview of war-related thermal injuries. J Craniofac Surg 2010; 21 (04) 971-975
• 19 Kauvar DS, Cancio LC, Wolf SE, Wade CE, Holcomb JB. Comparison of combat and non-combat burns from ongoing U.S. military operations. J Surg Res 2006; 132 (02) 195-200
• 20 Creamer KM, Edwards MJ, Shields CH, Thompson MW, Yu CE, Adelman W. Pediatric wartime admissions to US military combat support hospitals in Afghanistan and Iraq: learning from the first 2,000 admissions. J Trauma 2009; 67 (04) 762-768
• 21 Fraulin FO, Illmayer SJ, Tredget EE. Assessment of cosmetic and functional results of conservative versus surgical management of facial burns. J Burn Care Rehabil 1996; 17 (01) 19-29
• 22 Petersen K, Hayes DK, Blice JP, Hale RG. Prevention and management of infections associated with combat-related head and neck injuries. J Trauma 2008; 64 (03) S265-S276
• 23 Abou Fayad A, Rizk A, El Sayed S. et al. Antimicrobial resistance and the Iraq wars: armed conflict as an underinvestigated pathway with growing significance. BMJ Glob Health 2023; 7 (Suppl. 08) e010863
• 24 Rudagi BM, Halli R, Kini Y, Kharkhar V, Saluja H. Foreign bodies in facial trauma-report of 3 cases. J Maxillofac Oral Surg 2013; 12 (02) 210-213
• 25 Rupert J, Honeycutt JD, Odom MR. Foreign bodies in the skin: evaluation and management. Am Fam Physician 2020; 101 (12) 740-747
• 26 Borzykh A, Laksha AM, Borzykh N, Laksha AA, Shypunov V. STRATEGY OF RECONSTRUCTIVE AND RESTORATIVE INTERVENTIONS FOR HAND TISSUE DEFECTS. Georgian Med News 2023; (338) 117-120
• 27 Nam J, Martin MJ. Human factors in military surgery. In: Cohen TN, Ley EJ, Gewertz BL. eds. Human Factors in Surgery, Enhancing Safety and Flow in Patient Care. Cham: Springer; 2020: 95-105
• 28 Aveta A, Casati P. Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients. Ann Ital Chir 2008; 79 (06) 415-417
• 29 Jeong TS. A multidisciplinary approach to polytrauma management. Korean J Neurotrauma 2024; 20 (01) 1-2
• 30 Kishore J, Vatsa R, Singh J, Kumari M, Kumar T, Bandgar S. Psychological impact on maxillofacial trauma patients - an observational study. J Med Life 2020; 13 (04) 458-462
• 31 Howard JT, Kotwal RS, Santos-Lazada AR, Martin MJ, Stockinger ZT. Reexamination of a battlefield trauma golden hour policy. J Trauma Acute Care Surg 2018; 84 (01) 11-18
• 32 Lane I, Stockinger Z, Sauer S. et al. The Afghan Theater: a review of military medical doctrine from 2008 to 2014. Mil Med 2017; 182 (S1): 32-40
• 33 Palines PA, Park SY, Loo RJ. et al. Facial reconstruction following self-inflicted gunshot wounds: predictors, complications, and acceptable outcomes. Trauma Care. 2022; 2 (02) 211-225
• 34 McCarty JC, Herrera-Escobar JP, Gadkaree SK. et al. Long-term functional outcomes of trauma patients with facial injuries. J Craniofac Surg 2021; 32 (08) 2584-2587
• 35 Priya J. Post traumatic stress disorder (PTSD) following craniomaxillofacial trauma - a five year retrospective study. J Surg Res Prac 2022; 3 (02) 1-20