Wartime Reconstructive Plastic Surgery

In October 2005, there were about 149,000 U.S. troops in Iraq, about 14,600 wounded and an increasing injury rate of 28.5 percent each day. In that setting, wartime plastic surgery became a very important topic of discussion. At the 2005 American Society of Plastic Surgeons conference, plastic surgeons from across the United States gathered to speak about the role of plastic surgery in Iraq.

"The biggest Iraq War threats are roadside bombs and high velocity guns," said ASPS Member Surgeon and Lieutenant Colonel (LTC) Andrew Friedman, MD. "Convoys are the highest risk activity that a soldier can participate in. You never know when there is going to be a bomb alongside you or under your vehicle. The guns used by the Iraqis cause much more damage than the guns found on America's streets," he said.

Although soldiers are equipped with protective gear such as plated body armor, the arms, face, and legs are exposed. Therefore, the most common injuries are wounds to the face as well as the upper and lower extremities. Plastic surgeons turn to their medical and general surgery skills to treat war wounds in the field. Initial emergency treatment for pain and infection is administered at the field site. Then the soldier is transported home to receive medical and reconstructive treatment.

Wartime Reconstructive Procedures

The treatment plan for a soldier requires the coordinated effort of different specialists. These specialists include internal medicine physicians, ophthalmologists, ear nose and throat specialists, psychologists, and plastic surgeons.

The plastic surgeon often plays a large role in the care of a soldier. During consultation with a plastic surgeon, the doctor will complete a medical evaluation. The doctor will also review the plastic surgeon's credentials, education, training, type of certification held, and number of times that the recommended procedure has been performed in the practice. Soldiers will be able to view before-and-after photos of patients who received different types of plastic surgery procedures to help set reasonable expectations for the procedure. Soldiers may bring photos of the result they would like to see, as well as photos taken prior to the injury. Soldiers are advised to inquire about the type of equipment and medical devices to be used, where the procedure will be performed, and the extent of the procedure. The doctor should be able to provide an idea of the best approach to treatment and expected results.

The following sections describe some of the plastic surgery procedures that may be required to improve the appearance of the face, arms, and legs.

Facial Wounds

Facial wounds may require initial suturing at the field site. Once the soldier is transported home, the plastic surgeon will develop a comprehensive treatment plan that may include major surgical procedures, minimally invasive, and non-invasive procedures. These surgical procedures might include facial implants to treat structural damage to the chin or cheeks, blepharoplasty to repair eye injuries, rhinoplasty for nose injuries, variations of a facelift for a distorted facial appearance, and a neck lift for certain neck reconstructive candidates. The treatment plan may also include fillers and injectables and other facial rejuvenation procedures to fill in hollowed or sunken facial areas. The treatment plan will address long-term implications such as hyperpigmentation (discoloration areas of the skin) and scarring. Treatment options for hyperpigmentation and scarring include laser treatments and chemical peels, among others.

Arm and Leg Wounds

Arm and leg wounds may require initial suturing at the field site. Once the soldier is transported home, the plastic surgeon will develop a comprehensive treatment plan. Depending upon the extent of the injury, reconstructive plastic surgery may be part of the treatment plan. The types of reconstructive procedures that may be required include body implants or body fat transfers. Minimally invasive and non-invasive procedures may also be part of the treatment plan. The treatment plan will address long-term implications such as hyperpigmentation (discoloration areas of the skin) and scarring. As with facial wounds, arm and leg treatment options for hyperpigmentation and scarring include laser treatments and chemicals peels.

Recovery

Using plastic surgery to treat wartime injuries helps soldiers to heal physically and emotionally. The journey home to America can be difficult. The treatment plan may require a year or more to complete. Plastic surgeons in the United States help make the recovery process more successful, giving injured soldiers the best care possible, rebuilding injured areas and helping them return to their normal lives.