Damage control surgery (DCS) in the management of maxillofacial bomb blast patients during the Yemen civil conflict. Neighboring Level 1 trauma hospital experience

Abstract

Study design: Application of Damage Control Surgery (DCS) in Oral and maxillofacial surgery is still evolving, therefore, the current study hopes to share our experience in the management of bomb blast patients. Objectives: The objectives of the current study is to share our experience in the management of maxillofacial bomb blast injuries emphasizing on DCS. Methods: This was a retrospective study of combatant Yemeni war patients who were transported across the border from Yemen and treated in Najran, Kingdom of Saudi Arabia from December 2015 to December 2019. Information such as etiology of injury, age, zone of injury and mechanisms of bomb blast associated injuries, treatment protocol and complications. The treatment protocols adopted include; DCS in which exploration to control soft tissue bleeding was done and when bone bleeding could not be controlled, immediate reduction and osteosynthesis of bone fractures was carried out. Early Definitive Surgery (EDS) was done in patients that were hemodynamically stable with open reduction and internal fixation (ORIF) of all facial bone fractures. Closed reduction and fixation were done with the use of arch bars while in conservative approach, patients were placed only on soft diet. Data was stored and analyzed using IBM SPSS Statistics for IOS Version 25 (Armonk, NY: IBM Corp). Results: A total of 235 (57.6%) patients sustained bomb blast injuries from the 408 war casualties. Other patients (42.4%) sustained other types of injuries. All the patients were males. Their ages ranged from 21 to 53 years with mean (SD) at 27.3 (5.6) years. DCS was carried out in a large proportion of the patients totaling 78 (33.2%) patients, while EDS was carried out in 58 (24.7%) hemodynamically stable patients. ORIF was the main treatment modality for the fractures in 136 (57.9%) of the patients. Conclusion: The result of the study showed a large proportion of the patients were managed with DCS. DCS should be seen as a strategy in stabilizing the patients before definitive surgery is performed.