Plastic surgery interventions for war-related injuries: a review of 300 cases from Sudan, a cohort study

War-related injuries present significant challenges to the health system, notably during the conflict period. The study aimed to evaluate the demographics, anatomical distribution, plastic intervention, immediate complications, and outcomes of war-injured patients presenting to our plastic surgery unit.

This retrospective, cohort, single-center study was conducted from January 2024 to December 2024 and included 300 war-injured patients treated in the plastic surgery unit, Atbara Hospital. The patients' demographic data, site of injuries, surgical management, and complications were documented.

The commonly affected age group was 20-30 (51.3%), followed by 30-40 (38.3%). The most common site of war injuries was the extremity: upper limb in 171 patients (57%), and lower limb in 108 patients (36%). The total number of surgical operations performed was 306, with split thickness skin grafts being the most common procedure in 104 (34%) patients. Local fasciocutaneous flaps were used in 60 (19.6%) patients, whereas muscle flaps were used in only 23 (7.5%) patients. The Reverse sural artery flap was the commonly used fasciocutaneous flap, used in 23 patients (7.5%). Surgical operations for nerves and tendons were performed in 63 (20.6%) and 56(18.3%) patients, respectively. The complication rate was 13%, with a wound infection rate of 8.5%.

The study highlights the predominance of extremity-related injuries and the reliance on simple reconstructive methods (split thickness skin grafts and pedicled flaps) to reconstruct war injuries in limited resource areas, in the absence of microsurgery services. Furthermore, the report highlights the crucial role of plastic surgery in conflict settings.