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Report of the Reconstructive Plastic and Maxillofacial Surgery in Austere Environments and War Zones



Marrakech, Morocco
October 30, 2014




The first annual symposium of Burns, Reconstructive Plastic and Maxillofacial surgery in War and Austere zones was held in Marrakech, Morocco on the 30th of October 2014. This event was organised by Professor Karim EL-KHATIB, head of Plastic and Maxillo-facial Surgery in the Mohammed V Military Hospital in Rabat, Morocco, and president of the “ad hoc” working group on war surgery in the International Committee of Military Medicine, in association with the Academic Plastic Surgery Group of Barts and The London School of Medicine and Dentistry, under the aegis of Professor Simon MYERS, Consultant Plastic and Burns Surgeon.

Bringing together an esteemed faculty of international experts, this meeting offered an in-depth insight into the experiences and management of the complexities and challenges of modern combat-zone injuries. The speakers represented the fields of Reconstructive Plastic surgery, Maxillofacial surgery, Anaesthesiology, Trauma Surgery, Burns Surgery and Military medicine. The audience was comprised of a great mix of over seventy attendees ranging from surgical interns to venerated professors from both civilian and military backgrounds.

The location chosen for the first edition of the symposium could not have been more ideal as Marrakech, rich with the culture and influences of Africa, Europe and Asia, represented the very nature of the conference: the meeting of highly-regarded medical professionals from all three continents for the purpose of forging relationships, advancing education and sharing expertise.

The first half of the day focused on the management of burn injuries sustained in areas of conflict. The audience was given a captivating insight into the challenges of treating these patients ranging from the management of phosphorus burns to blast injuries. The esteemed speakers honouring this session included: Professor Siah of the Rabat Hospital in Morocco, discussing the challenges of air-ambulance transfers in severe burns injuries and his experience of phosphorus burns; Professor CARSIN from Metz in France and Dr BOUKIND of Casablanca discussing war-related burn injuries and the logistical hurdles of dealing with massive influxes of burns patients into military and medical facilities; Dr Ali GHANEM, based in London, discussing the harrowing consequences of patients sustaining Phosphorus burns in Gaza and the immense challenges faced in their management; Dr BERTIN-MAGHIT of Lyon, presenting his experience of burns poly-trauma patients and blast injuries; Professor Simon MYERS from the Royal London Hospital discussing the very current and challenging topic of terrorist attack-induced burn injuries in civilians and lastly, Professor BEY of Paris presenting his findings on the treatment of radiation burns.

Following a pleasant lunch where the animated debates and exchange of ideas continued, the faculty and audience re-convened for an afternoon of plenary sessions focusing on reconstructive Plastic and Maxillofacial Surgery in war-zones and austere environments. This exciting session was opened by Professor EL KHATIB who discussed the role of reconstructive plastic surgeons in war-zones, through his own experiences. This was followed by a truly riveting lecture from Mr Ghassan ABU-SITTA, Chief of Plastic Surgery at the American University of Beirut, who shared his insightful, often haunting personal involvement in treating victims of the Iraq, Syria and Gaza conflicts and the reconstructive hurdles he and his team were faced with. Mr NASSER, a London-based Maxillofacial surgeon, then presented his experience of managing complex nasal injuries, both due to combat-associated injuries as well as in civilian and elective practice. The day’s proceedings were finally concluded by talks from Dr HELALI, describing the Tunisian experience of the late management of maxillofacial trauma sustained in Libya, on behalf of Professor ADOUANI and Miss THEODORAKOPOULOU, based in London who presented the findings of a systematic literature review on free-flap reconstruction of combat-associated extremity injuries.

Throughout the day, the sessions were supported with synchronous translations from English to French and vice-versa, using personal headsets, ensuring that the international faculty could exchange their ideas and experiences freely, without the hindrance of language barriers.

In the current climate of political instability and constantly-erupting conflicts, the coming together of esteemed experts in the field, and the exchange of experiences and ideas was an invaluable opportunity that imparted all those present with a wealth of information. Now more than ever the need to openly discuss the management of this difficult and unique group of patients is absolutely essential. Experts in the field, those that perhaps have had the greatest insight and hands-on experience are those that often do not have the luxury to widely publish their work, limited by the constraints of their hectic clinical obligations and the austere environments in which they are based. For this reason, meetings such as these where combat surgeons can engage with their colleagues and share their views and practices, are of paramount importance as a means of propagating knowledge in this taxing field of medicine. The symposium was therefore instrumental in establishing and strengthening the relations between our international faculty that will hopefully become a platform for future collaborations, clinical fellowships, formal academic endeavours and scientific meetings.

We all hope to meet again in 2015 for the second annual meeting of this exciting event, to continue building upon the professional friendships and to further our collective education in the complex and challenging field of combat surgery.