The Benefit of Inevitably Delayed Surgical Intervention Following High-Velocity Maxillofacial War Injuries

Background: Over 3200 Syrian patients were admitted and treated at Galilee Medical Center (GMC) over a five-year period (May 2013 - May 2018) since the beginning of the Syrian civil war in 2011. This study compares the number of postoperative complications of patients admitted to the GMC immediately after injury or two to three weeks after initial high-velocity maxillofacial injuries and the potential mechanisms for the variation in complication rates. We describe our experiences, strategies, and resultant treatment approach.Methods: Retrospective case studies in which the incidence of complications including infection, rejection of hardware, bone or soft tissue grafts, tissue dehiscence, oroantral fistula formation, excessive scarring, and unplanned return to the operating theater were investigated. Patients arriving at the GMC within 24 hours following maxillofacial injury were considered “early” while patients arriving to the GMC within 14-28 days following initial trauma without treatment prior to arrival were considered “late” or “delayed.” Both groups of patients received definitive surgical treatment within 48 hours of admission to our hospital. Results: Sixty patients suffering from "high-velocity" maxillofacial Syrian civil war-related battlefield injuries were included in this study. The mean age was 26±8 years (range: 9-50) and all except one were male. Post-operative complications in the early group were found to be significantly higher compared to the delayed group (p = 0.006).Conclusions: We discovered that the delayed group of patients, characterized by progressive neovascularization of injured tissue, had better surgical success from rich blood supply that enhances tissue survival. Sustained tissue perfusion to the tissue supports efficient systemic antibiotic delivery, a favorable condition in lowering infection rate and complication. We found that the unintendedly delayed treatment contributed to a critical revascularization period resulting in improved healing and decreased postoperative morbidity and complications.