Delaying treatment of facial and head injuries caused by high-velocity weapons may actually lead to a better outcome, according to a study led by Bar-Ilan University researchers published in January in the journal Scientific Reports.
The study was conducted by evaluating medical files of Syrians who suffered maxillofacial injuries caused by high-velocity weapons and were treated in Israel during the Syrian Civil War. High-velocity weapons include machine guns, IEDs and missiles.
The Galilee Medical Center treated about 3,200 Syrian patients during the war from May 2013 to May 2018 as part of Israel's Operation Good Neighbor and hundreds of those treated suffered from high-velocity weapons injuries. While some patients were treated immediately after their injuries, for others it took as long as 28 days to reach Israel.
Prior studies into such injuries conducted in Iraq, Afghanistan and Israel have resulted in two main approaches to treatment: either rapid and immediate treatment or delayed and staged treatment.
The recently published study led by Prof. Samer Srouji, member of the Azrieli Faculty of Medicine of Bar-Ilan University and Chief of the Oral and Maxillofacial Institute at Galilee Medical Center, found that those who were treated at least two weeks after injury faced less complications than those treated within 24 hours after injury. Researchers from Tel Aviv University and the Galilee Medical Center also contributed to the study.
While 64% of the patients treated within 24 hours after injury suffered complications, only 28.5% of the patients treated more than two weeks after injury suffered complications. Comparison of each type of complication experienced also found that the patients treated later had significantly fewer complications than those treated early.
The researchers hypothesized that the delay gives blood vessels at the site of injury time to self-repair, improving blood supply to injured tissue and possibly serving as the cause for the lower complication rates among patients treated after 14 days in a staged surgical approach.
"We believe that this benefit stems from neovascularization, the formation and repair – over time -- of blood vessels in the injured region, which improves the supply of blood and oxygen to the area and, in turn, leads to smoother healing and fewer complications following surgery," explained Srouji. “This study also highlights the important interface between bedside and basic research in the lab. We are currently working on 3D organ printing methods to develop artificial organ scaffold optimized for ideal oxygenation bone construction and rapid wound healing.”
The researchers stressed that it is still impossible to draw unequivocal conclusions on the ideal time for surgical treatment, but added that the study does indicate that delayed treatment can improve surgical outcomes and prevent complications. The research could lead to a reassessment of protocols concerning the speed of treatment of high-velocity head and facial injuries.
The research additionally provided insight into injuries caused by sniper fire and high-velocity injuries. Researchers have developed a laboratory model that simulates these injuries and are continuing to collect and process data from the treatment of victims of the Syrian Civil War.