title: The Role of Military Plastic Surgeons in the Management of Modern Combat Trauma: An Analysis of 645 Cases.
abstract: BACKGROUND
  Plastic surgery has historically been linked to war. Between 2008 and the end of combat operations in Afghanistan in 2014, British military plastic surgeons formed part of the multinational military surgical team at the Role 3 Medical Treatment Facility, Camp Bastion, Helmand Province. The present study aimed to analyze the activity of these surgeons objectively and to determine the utility of their deployment.
  
  
  METHODS
  Data were gathered prospectively from four periods (2009 to 2012). This coincided with different surgeons, types of combat activity, wounding patterns, and mission emphases for the hospital. Various metrics were employed.
  
  
  RESULTS
  Plastic surgeons were involved in 40 percent of surgical cases (645 of 1654). This was consistent, despite changes in the predominant wounding mechanism and casualty population. One-third of cases involved the plastic surgeon as the lead or sole surgeon and two-thirds involved working with surgeons from other disciplines. Caseload by anatomical region was as follows: hand and upper limb, 64 percent; head and neck, 46 percent; lower limb, 40 percent; and trunk, 25 percent. A median of 1.75 body areas were operated on per patient. Involvement did not differ between patients wearing combat body armor when injured and those who were not.
  
  
  CONCLUSIONS
  Plastic surgeons played a significant role in the management of modern military trauma. This reflects the types of injuries sustained and the expertise of military plastic surgeons complementing the skill set of the other surgical team members. The level of activity was independent of wounding patterns, suggesting that the specialty may be useful, irrespective of the nature of the conflict.
authors.affiliation: Birmingham, United Kingdom.|From the Academic Department of Military Surgery and Trauma, Department of Military Surgery and Trauma, Royal Centre for Defence Medicine.
authors.forename: Laura
authors.initials: L
authors.lastname: Maitland
authors.affiliation: Birmingham, United Kingdom.|From the Academic Department of Military Surgery and Trauma, Department of Military Surgery and Trauma, Royal Centre for Defence Medicine.
authors.forename: Graham
authors.initials: G
authors.lastname: Lawton
authors.affiliation: Birmingham, United Kingdom.|From the Academic Department of Military Surgery and Trauma, Department of Military Surgery and Trauma, Royal Centre for Defence Medicine.
authors.forename: James
authors.initials: J
authors.lastname: Baden
authors.affiliation: Birmingham, United Kingdom.|From the Academic Department of Military Surgery and Trauma, Department of Military Surgery and Trauma, Royal Centre for Defence Medicine.
authors.forename: Tania
authors.initials: T
authors.lastname: Cubison
authors.affiliation: Birmingham, United Kingdom.|From the Academic Department of Military Surgery and Trauma, Department of Military Surgery and Trauma, Royal Centre for Defence Medicine.
authors.forename: Rory
authors.initials: R
authors.lastname: Rickard
authors.affiliation: Birmingham, United Kingdom.|From the Academic Department of Military Surgery and Trauma, Department of Military Surgery and Trauma, Royal Centre for Defence Medicine.
authors.forename: Alan
authors.initials: A
authors.lastname: Kay
authors.affiliation: Birmingham, United Kingdom.|From the Academic Department of Military Surgery and Trauma, Department of Military Surgery and Trauma, Royal Centre for Defence Medicine.
authors.forename: Shehan
authors.initials: S
authors.lastname: Hettiaratchy
mesh_terms: D055826:Afghan Campaign 2001-; D006801:Humans; D008889:Military Personnel; D010819:Physician's Role; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D013518:Surgery, Plastic; D006113:United Kingdom; D000067398:War-Related Injuries / Q000601:surgery*