The role of the plastic surgeon in dealing with soft tissue injuries: experience from the second Israel-Lebanon war, 2006.

During the 2006 war between Israel and Lebanon, 282 Israeli soldiers were evacuated to Rambam Health Care Campus. Of these, 210 were admitted for observation or treatment, and 15 of these were admitted to the Department of Plastic and Reconstructive Surgery. Thirty-five other soldiers, hospitalized in other departments, required the care of Plastic Surgeons, either for conservative or surgical treatment. The injury profile observed was consistent with data from previous low-intensity warfare, which demonstrated that over 80% of injuries were produced by fragmentation weapons, such as artillery, mortarshells, rockets, and missiles. It differs, however, from our experience in previous wars and our expectations regarding burn wounds, both in incidence and severity, which were significantly lower as compared with the past. This article presents our management of extensive soft tissue injuries, and details 3 representative cases. It highlights the role of the Plastic Surgeon as part of the whole treatment in this type of injury and helps to predict the needs of the medical system in preparation for the future.

Postburn scalp reconstruction using a self-filling osmotic tissue expander.

Tissue expanders have been used in the past few decades for various reconstructive procedures. The conventional expander requires serial filling injections in repeated visits over a few months period, and carries a substantial complication rate. An osmotic self-filling expander was invented ten years ago, but has still not gained a wide spread use. We describe here our first experience with this expander in reconstruction of a post-burn scalp scar in a young patient, and discuss its advantages: no filling injections are needed, thus lowering the possibility of infection and significantly reducing the number of required visits to the outpatient clinic; the swelling is much more gradual and subtle and there is no pain that usually follows the filling injection; the small initial volume of the expander requires a relatively small pocket and can be performed under local anesthesia and results in a relatively short scar.