Gunshot wounds to the face: level I urban trauma center: a 10-year level I urban trauma center experience

Fracture Patterns in Craniofacial Gunshot Wounds: A Seven-Year Experience

OBJECTIVE

To characterize facial fracture patterns and understand predictors of surgical repair and LOS with the objective of assisting providers in managing and understanding these complex injuries.

STUDY DESIGN

This is a retrospective cohort chart review study.

METHODS

A retrospective review was conducted for patients admitted with gunshot wounds (GSWs) to the head, neck, or face between January 2013 and March 2020 at a level one trauma tertiary care hospital. Univariate and multivariate analysis were performed to identify associations with surgical repair and LOS.

RESULTS

Of the 578 patients with head, neck, or facial GSWs, 204 survived and sustained facial fractures. The maxilla (n = 127, 62%), orbit (n = 114, 55%), and mandible (n = 104, 51%) were the most fractured. Operative rates differed by location (p < 0.001) with highest rates for fractures involving the mandible (76%). In univariate analysis, overall facial fracture surgery was associated with transfacial injuries; mandible, palate and nasal fractures; tracheostomy; gastrostomy tube placement; ICU admission; and a longer-than-24 h ICU stay (all p < 0.05). In multivariate analysis, predictors of surgical repair included a length of stay greater than 3 days (OR 2.9), transfascial injury (OR 3.7) and tracheostomy placement (OR 5.1; all p-values < 0.05), while nasal and mandible fractures were also associated with overall operative repair (OR 2.5 and 9.3, respectively; p-value < 0.05 for both). Univariate analysis showed that among patients with GSW injuries who underwent facial plastic reconstructive surgery (FPRS) with comorbid serious polytrauma, the inpatient LOS was predicted solely by the presence of subarachnoid, subdural and intracranial hemorrhage (p-value < 0.005). Subsequent multivariate analysis found that the only predictor for greater hospital LOS for patients who underwent surgical repair was earlier timing to FPRS of less than five days (OR 0.17) and placement of a gastrostomy tube (OR 7.85).

CONCLUSIONS

Managing facial fractures in GSW patients requires complex medical decision making with a consideration of functional and esthetic outcomes in the context of concomitant injuries and overall prognosis. Certain characteristics such as ICU admission, longer hospital stay, trajectory of GSW, tracheostomy placement, and specific operative locations are associated with higher rates of operative repair. Inpatient hospitalization LOS for patients who underwent FPRS was predicted by timing from admission to surgical repair.

Management of Avulsive Soft Tissue Ballistic Facial Injuries

Ballistic facial injuries are rare yet challenging cases for plastic surgeons that often comprise of avulsive tissue loss. They require in-depth assessment and staged reconstruction after patient stabilization. Each anatomic region of the face holds specific considerations that should be prioritized during reconstruction. Soft tissue repair techniques of facial gunshot wounds are widely variable and range from primary closure to multistage free flaps. Large, devastating facial defects after ballistic trauma previously posed significant challenges for reconstruction; however, advances in composite tissue transplant and allografts have expanded plastic surgeons' reconstructive arsenals. The goal of this review is to focus on the fundamentals of soft tissue management and reconstruction after ballistic facial injury. Through sound surgical principles, patients may achieve optimal aesthetic and functional outcomes despite experiencing highly morbid facial ballistic injuries.

Does Facial Gunshot Wound Location Affect the Need for Airway Intervention?

Purpose

The purpose of this study was to determine the effect of the facial region associated with gunshot wound (GSW) on the need for airway intervention.

Methods

This was a cross-sectional study. We reviewed charts of patients treated at Cook County Health from (2008-2018) for GSW injuries involving the face. Data collection included demographics and airway intervention. The region of the face involved in GSW was the predictor variable. Airway intervention via intubation, cricothyrotomy, or tracheostomy was the outcome variable. Chi-square tests and odds ratios were employed for statistical analyses.

Results

Of the 180 GSW patients, 169 were males (94%), and eleven were females (6%). 145 were African American (80.6%), 21 were Hispanic (11.7%), 5 were Caucasian (2.8%), and 9 were of other ethnicities (5%). The median age in this cohort was 25 years (range 16-73 years). The mean was 27.9 years, and 75% of patients were younger than the age of 33 years. The overall rate of airway intervention was 45%. Among patients with injuries to the lower face, 53% required airway management, compared to 33% of patients with injuries to the middle face and 30% of patients with injuries to the upper face. This difference was not statistically significant. Dichotomized data into the upper half and lower half injuries of the face reflected a statistically significant difference in the need for airway intervention (chi-square 4.358, p = 0.037). The odds ratio was 0.3824 and a 95% confidence interval was 0.1532-0.9545.

Conclusion

While only half of GSW patients may require airway intervention, vigilance and close attention should be paid to all patients and especially those with lower half of the face injuries.

Intracranial Gunshot Wounds: An Assessment of Patient Characteristics on Surgical Outcomes

BACKGROUND/OBJECTIVE

Intracranial gunshot wounds (GSW) are often fatal, with most patients dying before intervention can occur. Surgical management, when indicated, results in decreased mortality. We sought to assess the neurosurgical outcomes and economic costs of intracranial GSW.

METHODS

We conducted a retrospective analysis using the longitudinal claims Truven MarketScan® database (IBM) from 2000 to 2016. Mortality was the primary outcome of interest. Complications, length of stay, and payment were secondary outcomes. Multivariable logistic and linear regression analyses were performed to assess the relationship between age, gender, insurance type, and the number of comorbidities in the outcomes measured.

RESULTS

We identified 315 patients (median age 34.0 years; interquartile range (IQR)=24, 48; 32.06% female) who received craniotomy or craniectomy for intracranial GSW. Mortality occurred in 44 patients (13.97%) and 234 patients (74.29%) experienced complications. The median length of stay was 13 days (IQR=5, 25 days), and the median cost was $70,624.00 (IQR=$32,378.00; $163,437.00). Increases in the Elixhauser index by one-comorbidity increments were associated with increased length of stay (risk ratio (RR)=1.207; 95% confidence interval (CI)=1.106-1.317) and payment (RR=1.135; 95% CI=1.036-1.243). Patients with respiratory complications, excluding infection, experienced an increased risk of mortality (odds ratio (OR)=3.486; 95% CI=1.623-7.485), length of stay (RR=1.649; 95% CI=1.321-2.060), and payment (RR=2.085; 95% CI=1.652-2.631).

CONCLUSIONS

Although these findings must be interpreted in the context of the limitations inherent to studies using national administrative data, the current study provides additional insight into the relationship between patient characteristics and outcomes after surgery for intracranial GSW.

Exploring Socioeconomic Disparities in Mandibular Trauma: A Retrospective Cohort Analysis of Patient Profiles and Treatment Outcomes

Study Design

Retrospective Chart Review.

Objective

Mandible fracture is a life-altering event, and its complications can have devastating consequences for patients. Patients are therefore well-served if providers can identify their risk factors and engage strategies to reduce complication risk. The present study examines mandible trauma in an urban tertiary hospital serving an economically disadvantaged population.

Methods

This review identified all patients undergoing operative repair of traumatic mandible fractures from January 2015 to December 2020. Patient risk factors, operative technique, and surgical complications (including infection, hardware failure, malunion, and mandible nonunion) were analyzed.

Results

Two hundred and seventy-two patients were identified with mandible fractures; 78.3% of these injuries were related to interpersonal violence; 83.4% of patients were male, and 55.5% were African American. Based on multivariable logistic regression models, increased rates of postoperative complications were observed in patients with increasing Area Deprivation Index (Odds Ratio 1.02), mandible body fracture (OR 3.11), tobacco use disorder (OR 3.75), history of hepatitis C infection (OR 7.35), and discharge to drug and alcohol rehabilitation (OR 23.42).

Conclusions

For providers treating patients with mandible fractures, the effects of comorbid substance use-including tobacco use-and inadequate discharge disposition (a reflection of financial means and insurance status) should be identified early, and steps to mitigate their consequences should be taken. Providers must recognize that patients with these comorbidities require more patience, support, and attention than patients without these risk factors. Increased engagement with multidisciplinary services such as psychiatry, addiction medicine, primary care, and social work may improve outcomes for these vulnerable patients.

The Medical Costs of Firearm Injuries in the United States: A Systematic Review

BACKGROUND

Firearm injury poses a significant public health burden in the United States.

OBJECTIVES

The purpose of this systematic review was to provide a comprehensive accounting of the medical costs of firearm injuries in the United States.

METHODS

A systematic literature review was conducted to identify studies published between January 1, 2000 and July 13, 2022 that reported medical costs of firearm injuries. A search of Embase, PubMed, and the Cochrane Library databases was performed by a medical librarian. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate for risk of bias. Health care-related charges and costs per firearm injury were presented and trends were identified.

RESULTS

Sixty-four studies were included in the analysis. Study sample sizes ranged from 18 to 868,483 patients. Reported costs per injury ranged from $261 to $529,609. The median cost reported was $27,820 (interquartile range [IQR] $15,133-$40,124) and median charge reported was $53,832 (IQR $38,890-$98,632). Studies that divided initial hospitalization costs and follow-up medical costs identified that initial hospitalization accounts for about 60% of total costs.

CONCLUSIONS

We found a significant volume of literature about the medical costs of firearm injury, which identified a highly heterogeneous cost burden. A significant amount of cost burden occurs after the index hospitalization, which is the only cost reported in most studies. Limitations of this study include reporting bias that favors hospitalized patients as well as a large focus on hospital charges as measurements of cost identified in the literature.

Ballistic Facial Trauma Reconstruction: Incidence and Practice Patterns in the Civilian Population

BACKGROUND

Management of nonfatal ballistic facial trauma is well described in the literature for wounds secondary to military combat. However, there is little literature describing such management in civilian practice. We aimed to describe nonmilitary patients with recent nonfatal facial injuries from ballistic trauma using the California Office of Statewide Health Planning and Development patient database.

METHODS

A retrospective study was performed using the California Office of Statewide Health Planning and Development Ambulatory Surgery and Inpatient datasets. All adults with the International Classification of Diseases, 10th Revision codes of severe nonfatal facial trauma from firearms requiring emergent surgery during 2016-2018 were included. Outcomes assessed include number and type of facial procedures performed, hospital length of stay, number of admissions, timing of definitive management, and lifetime hospitalization costs.

RESULTS

A total of 331 traceable patients were identified over this 3-year period. The average age was 35.4 years (SD, 15.2), and 87% were male. The median index admission length of stay was 8 days (interquartile range, 3-15 days). Subsequent readmission was required for 123 (37.2%) patients with 10% mortality in the index admission. Total median charges per patient for all admissions were $257,804 (interquartile range, $105,601-$531,916). A total of 215 patients (65%) had at least 1 facial repair performed. Of all 331 patients, 64.3% underwent musculoskeletal repair (n = 213), 31.4% underwent digestive system repair (n = 104), and 29.6% underwent respiratory system repair (n = 98). The average number of repairs per patient was 2.52 (SD, 3.38), with 35% not having any of the specified International Classification of Diseases, 10th Revision repair codes. A total of 27% of patients had 1 procedure performed, whereas 38% received 2 or more, for an average of 3.87 (SD, 3.5) repairs over the study duration.

DISCUSSION

To our knowledge, this is the first assessment of civilian characteristics of nonfatal ballistic facial trauma in California. Nonfatal facial ballistic trauma results in complex injuries to multiple body systems, requiring long admissions, costly hospital stays, and coordination of care across several surgical specialties. Many patients require a variety of procedures over multiple admissions, highlighting the overall morbidity of these injuries. Future studies will look at how care for these patients differs between various hospitals and geographic regions and whether current civilian management aligns with well-defined military reconstructive protocols for facial ballistic injuries.

Utilization of Ophthalmic Management in Patients with Head-and-Neck Trauma Secondary to Firearms

Introduction

This retrospective cohort study presents the epidemiology of severe firearm-related ophthalmic injury and the level of ophthalmology involvement in the multidisciplinary management of head-and-neck gunshot injuries.

Methods

A retrospective study identified 207 patients with firearm-related injuries involving the head and neck treated at an Academic Tertiary Care Institution from 2010 to 2020.

Results

Ophthalmology consulted on 29% of patients with head-and-neck firearm injuries. At least one of the services managing facial trauma (plastic surgery and otolaryngology) consulted on 71.5% of cases (P < 0.001). Of patients evaluated by ophthalmology, 93.3% survived to discharge; 78.2% of patients who were not evaluated survived to discharge (P = 0.009). Ophthalmology consulted on all patients with open globe injury (10.6%) (P < 0.001), all of which were evaluated by the facial trauma service (P = 0.002), 77.3% by otolaryngology (P = 0.42), 50% by neurosurgery, 36.4% by plastic surgery, 13.6% by orthopedic surgery, and 4.5% by vascular surgery. Ophthalmology consulted on 76.5% of patients with orbital fracture (32.9%) (P < 0.001); 83.8% were evaluated by the facial trauma service (P = 0.006), 69.1% by otolaryngology (P = 0.014), 54.4% by neurosurgery, 27.9% by plastic surgery, 10.3% by orthopedic surgery, and 2.9% by vascular surgery. For patients with orbital fractures, 92.3% survived when ophthalmology was consulted (P = 0.698); 43.8% survived when not consulted (P = 0.001).

Conclusions

Firearm-related injuries of the head and neck frequently involve ocular and orbital structures, often causing serious vision-threatening injuries. Multispecialty management is common and early ophthalmology specialist evaluation and co-management are indicated to best identify ophthalmic injuries.

Evidence-Based Medicine for Ballistic Maxillofacial Trauma

Ballistic trauma is a serious health issue with significant costs to physical, psychosocial, economic, and societal well-being. It may be caused from firearms, explosive devices, or any other projectile forces, and is characterized by severe tissue loss and evolving tissue devitalization. This review covers mechanism, diagnosis, and management of ballistic maxillofacial trauma, specifically. Initial evaluation includes stabilization of airway, bleeding, and circulation, followed by assessment of other injuries. The overall degree of tissue damage is determined by intrinsic patient factors and extrinsic projectile factors. Management of ballistic injuries has shifted toward advocation for early operative repair with the advent of antibiotics and advanced techniques in maxillofacial reconstruction. Appropriate timing and method of reconstruction should be carefully selected on a case-by-case basis. While ballistic trauma research is limited to studies biased by institutional practices, areas for further study identified from current literature include guidelines directing timing of reconstructive surgery; thresholds for free tissue transfer; handling of retained projectiles; incidence of surgical complications; and clinical outcomes for computer-aided surgical repair of these highly destructive injuries.

Is Maxillofacial Gunshot Wound Location Associated With Operative Intervention?

PURPOSE

Gunshot wound (GSW) injuries are an important public health concern in the United States. The study purpose was to measure the association between GSW location and need for operative treatment.

METHODS

This was a retrospective cohort study. Sample consisted of all patients treated for maxillofacial gunshot wound injuries at Cook County Health from 2008 to 2018. The sample data were collected through a retrospective charts review and review of computed tomography imaging. The predictor variable was the region of the face involved with the GSW and it was divided into 3 levels, upper face (UF), middle face (MF), and lower face (LF). The outcome variable was whether operative intervention was rendered or not (operative vs no intervention). Other variables of interest collected included patient demographics, the type of surgical intervention, disposition (home vs rehab/morgue), rate of intracranial injury, and need for blood transfusion. Data analysis was performed using Chi-square for proportions and relative risk (RR) with 95% confidence interval (CI).

RESULTS

A total of 180 patients were identified to have sustained GSW injuries to the face during abovementioned time frame. Of those, 120 patients had isolated GSW injuries with no other organs involvement. The median age was 25 years. Majority of the patients were males (94%). The involved facial region appeared to influence the need for operative management and this reached statistical significance (Chi-square 22.703, P < .001). GSW injuries to LF were 2.94 times more likely to require operative intervention than injuries to the MF (RR = 2.94, 95% CI = 1.625-5.327). Injuries of the UF were 2 times more likely to require operative intervention than injuries of the MF (RR = 2.03, 95% CI 1.023-4.008). Injuries to the UF were more likely to be associated with intracranial injuries (Chi-square = 20.522, P < .001).

CONCLUSIONS

In patients with facial GSW injuries, there is an association between injury location and the need for operative intervention. Injuries to the LF were most likely to require surgical intervention followed by the UF and MF, respectively.

Airway management in self-inflicted gunshot wounds to the face

Background

This study characterizes the prehospital and trauma bay airway management of self-inflicted gunshot wounds (SI-GSWs) to the face.

Methods

We reviewed SI-GSWs to the face from 2017 to 2021. Patients with isolated temporal GSWs were excluded. Emergency Medical Services (EMS) and trauma bay information on airway management were collected.

Results

38 patients presented with a SI-GSW to the face. 20 of the 29 transported by EMS were managed without advanced airways. There were four endotracheal intubations, three supraglottic airways, and two failed intubations. Those with advanced airways had lower GCS (3 vs. 15, p<0.01) and systolic blood pressure (94 vs. 144, p<0.01). After hospital arrival, 22 SI-GSWs were endotracheally intubated in the trauma bay and two in the OR. No cricothyroidotomies were performed.

Conclusions

A majority of SI-GSWs to the face can be managed by EMS using noninvasive support. Supraglottic airways may be an option for those requiring invasive support.

Repercussions on work, health and family relationships of police officers wounded by gunshot to the face

Abstract This article aims to identify the profile of police officers who underwent surgery due to gunshot wounds to the face, to survey the anatomical distribution of injuries and the repercussions on their health, work and family relationships. We conducted a retrospective epidemiological study based on secondary data of police officers who underwent surgery at the Central Military Police Hospital of the state of Rio de Janeiro due to gunshot wounds to the face from June 2003 to December 2020 (N=87). We also adopted a qualitative approach by applying a questionnaire with open and closed questions (N=37) to survey repercussions of the violent event on police officers’ work, families and health. The profile of police officers who underwent surgery showed that they were exclusively males, aged 34.9 years on average, privates, and injured in the line of duty. Fractures of the mandibular region were the most frequent injuries. After the accident, physical health conditions of police officers deteriorated, including an increase in cases of hypertension, a high frequency of insomnia (59.4%), and headache (51.3%). Damaged family relationship included an increasing trend of self-isolation and a feeling of fear experienced by police officers’ family members.

Repercussions on work, health and family relationships of police officers wounded by gunshot to the face

This article aims to identify the profile of police officers who underwent surgery due to gunshot wounds to the face, to survey the anatomical distribution of injuries and the repercussions on their health, work and family relationships. We conducted a retrospective epidemiological study based on secondary data of police officers who underwent surgery at the Central Military Police Hospital of the state of Rio de Janeiro due to gunshot wounds to the face from June 2003 to December 2020 (N=87). We also adopted a qualitative approach by applying a questionnaire with open and closed questions (N=37) to survey repercussions of the violent event on police officers' work, families and health. The profile of police officers who underwent surgery showed that they were exclusively males, aged 34.9 years on average, privates, and injured in the line of duty. Fractures of the mandibular region were the most frequent injuries. After the accident, physical health conditions of police officers deteriorated, including an increase in cases of hypertension, a high frequency of insomnia (59.4%), and headache (51.3%). Damaged family relationship included an increasing trend of self-isolation and a feeling of fear experienced by police officers' family members.

Comprehensive Treatment and Reconstructive Algorithm for Functional Restoration after Ballistic Facial Injury

Background:

Ballistic facial injuries are rare, with most trauma centers reporting 1–20 cases annually. These patients present significant management challenges to reconstructive surgeons, not only due to their rarity but also due to the complex decision-making process that is involved. The aim of this study was to review our experience with the application of craniofacial microsurgery in management of facial gunshot wounds.

Methods:

A retrospective review of a single-surgeon experience at a level I trauma center from 2011 to 2020 for patients sustaining self-inflicted gunshot wounds to the face requiring microsurgical reconstruction was performed. Outcomes included reconstructive techniques, free flap type and indication, airway evolution, feeding modality, respective timing of interventions, and complications.

Results:

Between 2012 and 2021, 13 patients presented for microsurgical reconstruction at our institution for gunshot wounds to the face. The majority (90%) of patients were men, and the average age at time of injury was 26. The median from the time of injury to first free flap was 93 days. Thirteen patients represented 23 free flaps. On average, patients underwent a total of two free flaps. The most common microsurgical flap was the fibula flap (14) followed by the radial forearm flap (6).

Conclusions:

Based on our findings, we describe a novel algorithm for function restoration and aesthetic revisions based on injury location. Underlying principles include avoiding early use of reconstruction plates, establishing occlusion early, and aligning bony segments using external fixation. An algorithmic approach to these injuries can improve outcomes.

An Algorithmic Approach to the Management of Ballistic Facial Trauma in the Civilian Population

Annual incidence of non-fatal ballistic civilian has been increasing for the last decade. The aim of the present study was to clarify the optimal reconstructive management of civilian ballistic facial injuries. A systematic review of PubMed was performed. Articles were evaluated for defect type and site, reconstructive modality, complications, and outcomes. A total of 30 articles were included. Most common region of injury was mandibular with a 46.6% incidence rate. All-cause complication rate after reconstruction was 31.0%. About 13.3% of patients developed a postoperative infection. Gunshot wounds had overall lower complication rates as compared with shotgun wounds at 9.0% and 17.0%. By region, complications for gunshot wounds were 35% and 34% for mandible and maxilla, respectively. Immediate surgical intervention with conservative serial debridement is recommended. However, for patients with pre-existing psychiatric disorders, secondary revisions should be delayed until proper psychiatric stabilization. When there is extensive loss of soft tissue in the midface, aesthetic outcomes are achieved with a latissimus dorsi or anterolateral thigh free flap. Radial forearm flap is favored for thin lining defects. Open reduction is suggested for bony-tissue stabilization. The fibula flap is recommended for bony defects >5 cm in both midface and mandible. For bony defects, <5 cm bone grafting was preferred. Delaying bone grafting does not worsen patient outcomes. Surgical treatment of ballistic facial trauma requires thorough preparation and precise planning. An algorithm that summarizes the approach to the main decision points of surgical management and reconstruction after ballistic facial trauma has been presented in this study.

Not just full of hot air: hyperbaric oxygen therapy increases survival in cases of necrotizing soft tissue infections

BACKGROUND

The utility of hyperbaric oxygen therapy (HBOT) in the treatment of necrotizing soft tissue infections (NSTIs) has not been proved. Previous studies have been subject to substantial selection bias because HBOT is not available universally at all medical centers, and there is often considerable delay associated with its initiation. We examined the utility of HBOT for the treatment of NSTI in the modern era by isolating centers that have their own HBOT facilities.

METHODS

We queried all centers in the University Health Consortium (UHC) database from 2008 to 2010 that have their own HBOT facilities (n=14). Cases of NSTI were identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, which included Fournier gangrene (608.83), necrotizing fasciitis (728.86), and gas gangrene (040.0). Status of HBOT was identified by the presence (HBOT) or absence (control) of ICD-9 procedure code 93.95. Our cohort was risk-stratified and matched by UHC's validated severity of illness (SOI) score. Comparisons were then made using univariate tests of association and multivariable logistic regression.

RESULTS

There were 1,583 NSTI cases at the 14 HBOT-capable centers. 117 (7%) cases were treated with HBOT. Univariate analysis showed that there was no difference between HBOT and control groups in hospital length of stay, direct cost, complications, and mortality across the three less severe SOI classes (minor, moderate, and major). However, for extreme SOI the HBOT group had fewer complications (45% vs. 66%; p<0.01) and fewer deaths (4% vs. 23%; p<0.01). Multivariable analysis showed that patients who did not receive HBOT were less likely to survive their index hospitalization (odds ratio, 10.6; 95% CI 5.2-25.1).

CONCLUSION

At HBOT-capable centers, receiving HBOT was associated with a significant survival benefit. Use of HBOT in conjunction with current practices for the treatment of NSTI can be both a cost-effective and life-saving therapy, in particular for the sickest patients.

Gunshot wounds to the face: emergency interventions and outcomes

BACKGROUND

Gunshot wounds to the face (GSWF) may produce life-threatening injuries. Our objective is to describe outcomes of and factors related to interventions for urgent airway control (UAC) and urgent bleeding control (UBC) as well as to analyze complications associated with GSWF.

METHODS

This was a retrospective study of 155 GSWF patients who were admitted to two Level 1 academic trauma centers over an 11-year period. Demographic details, injuries sustained, interventions performed, and timing of the interventions were recorded. Morbidity and mortality data were evaluated.

RESULTS

Overall, 115 (74 %) patients suffered isolated GSWF, and none died. Of the 90 (58 %) patients requiring UAC, only three had a cricothyroidotomy. Of the 41 (26 %) patients requiring UBC, only four had angiographic embolization. Intraoral involvement and extrafacial injuries were associated with both UAC and UBC. Overall, 75 patients (48 %) required operations on the bones, eyes, or both. Complications developed in 14 and were treated successfully.

CONCLUSIONS

UAC and UBC are required frequently after GSWF and are associated with intraoral involvement and injuries beyond the face. Simple methods, such as orotracheal intubation and packing, are typically sufficient for successful management. About half of the patients need further surgery, with infrequent morbidity.

Epidemiology, demographics, and outcomes of craniomaxillofacial gunshot wounds in a level I trauma center

BACKGROUND

Gunshot injuries to the craniomaxillofacial region are a challenge to the trauma and reconstructive surgeon. Although management of these injuries has been standardized and early rather than late intervention is advocated, the patient characteristics before, during, and after have been poorly elucidated.

METHODS

A prospectively maintained Level I trauma center database was queried as to gunshot wounds of the craniomaxillofacial skeleton. Over a five-year period (2007-2011), 168 patients were identified with these injuries. Charts were reviewed as to demographics, presentations, and outcomes and these were tested for significant relationships with hospital length of stay, numbers and types of procedures, morbidity, and mortality.

RESULTS

Gunshot wounds to the craniofacial skeleton resulted in 71 deaths in this patient population. Those that died were significantly older, presented with a lower GCS, had a shorter LOS, and a higher INR than those that lived. Subgroup analysis of mechanism demonstrated mortality was more likely to occur as a result of self-inflicted injury in whites and due to assault in the African-American population.

CONCLUSIONS

Data gathered from this study disputes some commonly held beliefs regarding the epidemiology of gunshot injuries and should allow for better characterization of which outcomes are consistent with which presentations.

Gunshot injuries in Benghazi-Libya in 2011: the Libyan conflict and beyond

BACKGROUND

Since independence, Libya has never experienced personal ownership of arms. That changed during the Libyan conflict where weapons became widespread in the society. As a result gunshot injuries became a concern for surgeons at our principal surgical hospital (Al-Jalaa). This study aims at analyzing the gunshot injuries that took place during 2011 and highlighting the peculiarities in the Libyan scenario.

METHODS

Patient records were obtained and gunshot injuries were analyzed for various parameters. Statistical analyses were made taking into consideration situations faced by neighbouring countries.

RESULTS

In 2011, 1761 patients were admitted with over 95% being male and over 97% were Libyan. The average age of a GSI patient was 28.32 ± 10.01 years. Patients aged 18-35 formed over 70% of the cases with half of all cases being treated by the orthopedics department. Sixty-eight percent of cases were injured in the extremities followed by chest (12.5%) and abdomen injuries (7.8%). The mortality rate for GSI's was found to be 5.6% overall with young age, site of injury (i.e. chest and head) and cause of injury (i.e. war or civilian fighting) being important risk factors.

CONCLUSIONS

Taking into consideration the difficult operating conditions and limited resources, surgeons at our hospital were able to maintain a low mortality rate. Disarmament needs to begin as soon as possible because these injuries will continue to occur so long firearms are available in society.