Craniofacial Soft Tissue Injuries in Gaza: Insights from a Plastic Surgeon's Notebook

The ongoing Israeli military invasion of the Gaza Strip has dismantled the territory's reconstructive surgery services. This retrospective analysis describes 74 soft tissue facial injuries treated by the plastic-reconstructive department at Al-Aqsa Martyrs' Hospital, Deir Al-Balah, between November 2023 and April 2024. Data were transcribed from a surgeon's handwritten notebook, corroborated with partial hospital records and photographs, anonymized, and analyzed using descriptive statistics plus Mann-Whitney U and the Fisher exact tests. Patients ranged from 2 to 65 years (median: 19.5); 46% were children under 16 and 49% were female. Blast mechanisms accounted for 88% of presentations, producing burns (30%), raw tissue loss (23%), and deep lacerations (22%), with retained shrapnel being documented in 11% of cases. More than half of patients sustained additional systemic injuries, with polytrauma significantly more frequent in females (P=0.0013). Surgical intervention occurred within 24 hours for 85% of cases; 49% involved a reconstructive procedure, most commonly an advancement or rotational flap. Postoperative complications arose in 19% of patients and were dominated by infection and keloid formation, and in-hospital mortality reached 7%, largely from extensive burns and sepsis. Although 97% of those needing higher-level care were referred for medical evacuation, only 54% were able to ultimately exit Gaza. This study showcases the disproportionate pediatric burden, high resource intensity, and evacuation bottlenecks characterizing facial trauma and treatment pathways amid the ongoing military attack and serves to underline the urgency of safeguarding surgical infrastructure and reopening humanitarian corridors.