War injuries to the head and neck

Area of Science:

• Otorhinolaryngology
• Cervicofacial Surgery
• War Surgery

Background:

• The 1991-1992 war in Croatia resulted in numerous casualties requiring specialized medical treatment.
• Dr Josip Bencević General Hospital treated 7,043 wounded individuals, with a significant subset presenting head and neck injuries.

Purpose of the Study:

• To analyze the characteristics and treatment outcomes of war-related head and neck injuries.
• To document the initial application of specific surgical procedures in a wartime setting.

Main Methods:

• Retrospective analysis of 728 patients with head and neck war injuries admitted to the Department of Otorhinolaryngology and Cervicofacial Surgery.
• Classification of injuries (head, neck, combined) and wound etiologies (shell/bomb fragments).
• Description of preliminary and definitive treatment strategies, including immediate neck exploration and novel reconstruction techniques.

Main Results:

• Head injuries were most common (74.3%), followed by neck injuries (16.0%) and combined injuries (9.6%).
• Shell and bomb fragments accounted for 74.5% of the injuries.
• Exploration of penetrating neck wounds was positive in 49 of 84 patients. Long-term complications included cranial plexus paralysis and neurological deficits.

Conclusions:

• War injuries to the head and neck present a significant challenge, often caused by explosive fragments.
• Primary wound closure with antibiotics and reconstruction of laryngotracheal injuries using cervical deep fascia represent innovative war surgery procedures.
• These novel techniques, applied during the conflict, may offer improved outcomes for severe head and neck trauma in wartime.