Shrapnel Injuries on Regions of Head and Neck in Syrian War.

Background: Perforating and cutting injuries to the head and neck due to shrapnels are largely life-threatening and require immediate medical attention. In the present article, the surgical conditions in the war-related head and neck injuries were presented in terms of war surgery with mortality rates.
Materials and Methods: The study was designed as a retrospective clinical case-control study including primarily 179 head and neck injuries that occurred due to shrapnels in the Syrian Civil War. The records of 2015-2019 years were analyzed according to demographics, injury types, injury location, plastic surgery approaches and postoperative outcomes.
Results: Injury mechanism of all wounds was penetrating type, which was commonly secondary to an explosive device, collapse due to shrapnels of the explosion, gunshot or grenade. While 43(24%) of the wounded were soldiers, 136 (76%) were civilians. Considering the reason for the shrapnel injury, 83% was due to the explosion and 17% was due to gunshot injuries. The 32% showed facial fractures. As the most common fractures of the face were around the maxilla-zygoma (28.4%), orbita (22%), and teeths (18.5%). Considering neck injury zones, region-2 was mostly affected by the region. The third zone had the lowest rate of injury with 10%. In 89 (49%) patients, the authors preferred primary, while 15 gained secondary reconstruction (8%). The authors used Limberg flap for 24 (32%) patients, rotation flap for 39 (52%) patients, and bilobe flap for 12 (16%) patients.
Conclusion: The most important cause of mortality was not the destruction, tissue loss caused by shrapnel injury, or experience of the surgeon, but the severe states of sepsis or multiple different trauma when brought for treatment from long range from the war zone.