Surgical challenges in a new theater of modern warfare: The French role 2 in Gao, Mali.
BACKGROUND
On January 11th 2013, France launched Operation Serval in Mali following Resolution 2085 of the Security Council of the United Nations. Between January and March 2013, more than 4000 French soldiers were deployed to support the Malian National Army and the African Armed Forces.


METHODS
All of the patients who had surgery during Operation Serval were entered into a computerised database. Patients' demographic data (age, sex, status) and types of performed surgical procedures (specialties, injury mechanisms) were recorded.


RESULTS
268 patients were operated on in Gao's Role 2 with a total of 296 surgeries. Among those operated on, 40% were Malian civilians, 24% were French soldiers, and 36% were soldiers of the International Coalition Forces. The majority of the surgeries were orthopaedic, and visceral surgeries were common as well, representing 43% of the total surgeries. Specialised surgical procedures including neurosurgery, thoracic, and vascular surgery were also performed. Forty percent of the surgeries were scheduled. War-related traumatic surgeries represented 22% of the surgical procedures, with non-war related surgeries and non-trauma emergency surgeries making up the rest.


CONCLUSIONS
this analysis confirms the specific characteristic of asymmetric warfare that it results in a relatively reduced number of war-related casualties. Forward surgical teams have to deal with a wide range of injuries requiring several surgical specialties. Surgeries dedicated to medical aid provided to the population also represented an important part of the surgical activity. Because of the diversity and the technicality of the surgical procedures in Role 2, surgeons had to be trained in war surgery covering all of the surgical specialties, while they maintained their specific skills. In France in 2007, the French Military Health Service Academy (École du Val-de-Grâce, Paris, France) offered an advanced course in surgery for deployment in combat zones, with a special focus on damage control surgeries and the management of mass casualties incidents.
14th Parachutist Forward Surgical Team, France; Department of Digestive Surgery, Val de Grace Military Teaching Hospital, 74 boulevard de Port Royal, 75005 Paris, France. Electronic address: bricemalgras@hotmail.com.
Brice
B
Malgras
14th Parachutist Forward Surgical Team, France; Department of Orthopedic Surgery, Begin Military Teaching Hospital, 69 avenue de Paris, 94160 Saint Mandé, France.
Olivier
O
Barbier
Medical Unit of the 8th French Military Parachutist Unit, avenue Jacques Desplats, 81100 Castres, France.
Ludovic
L
Petit
Clinic of Traumatology and Orthopaedics, Percy Military Teaching Hospital, 101 avenue de Henri Barbusse, 92140 Clamart, France.
Sylvain
S
Rigal
French Military Health Service Academy, Ecole du Val de Grace, 1 place Alphonse Laveran, 75005 Paris, France.
François
F
Pons
14th Parachutist Forward Surgical Team, France; Intensive Care Unit, Begin Military Teaching Hospital, 69 avenue de Paris, 94160 Saint Mandé, France.
Pierre
P
Pasquier
D002983:Clinical Competence / Q000592:standards*; D005602:France / Q000453:epidemiology; D006801:Humans; D008302:Mali / Q000453:epidemiology; D008887:Military Medicine / Q000639:trends; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D014194:Traumatology; D000067398:War-Related Injuries / Q000401:mortality / Q000601:surgery*; D014857:Warfare
Africa; Role 2; Surgery; War