Perioperative Management of Complex Mandibular Combat Trauma

Area of Science:

• Reconstructive Surgery
• Global Health
• Trauma Care

Background:

• The "Face to Face" initiative facilitated collaboration between American and Ukrainian (UA) medical professionals to address the rising demand for medical services due to combat injuries.
• This collaboration aimed to improve treatment and rehabilitation outcomes, optimize resource utilization, and enhance staff qualifications in Ukraine.

Purpose of the Study:

• To evaluate the outcomes of free fibula flap procedures performed during an international surgical training collaboration in Ukraine.
• To compare surgical outcomes, including complications and length of stay, between Ukrainian patients and established United States benchmarks.

Main Methods:

• Retrospective review of medical records from 2022 to 2024 at a single institution in Lviv, Ukraine.
• Inclusion criteria: patients who underwent free fibula flap surgery with complete medical records.
• Data collected included patient demographics, surgical techniques, operative time, length of stay, and complications.

Main Results:

• Eighteen free fibula flap procedures were performed (6 during the mission, 12 independently).
• All patients were male, with a median age of 34.5 years. Median surgical time was 595 minutes, and median postoperative hospitalization was 25 days.
• Acute wound complications occurred in 61.1% of cases, including infections in 27.8%, with one case resulting in flap loss. Hematomas were absent; one instance of salivary drainage was noted.

Conclusions:

• Outcomes of free fibula flap procedures in Ukraine were comparable to US results, but with a higher incidence of acute wound complications and longer hospital stays.
• International surgical collaboration enhances Ukraine's capacity for complex reconstructive procedures, particularly for combat-related injuries.
• Continued international partnerships are crucial for cultural exchange and improving patient outcomes in Ukraine.