ORTHOPLASTIC STRATEGIES FOR BONE INFECTION MANAGEMENT IN WAR ZONES: LESSONS FROM GAZA

Introduction Management of open fractures and bone infection in war zones presents a unique challenge. The orthoplastic approach—typically reliant on access to diagnostics, theatre availability, and specialised equipment—must be radically adapted in resource-poor, high-pressure settings. Drawing on field experience from Gaza, this presentation outlines practical, staged strategies for managing complex limb injuries and infections when best-practice protocols are not feasible. Methods Over several missions to Gaza, orthoplastic techniques were adapted to suit the constraints of wartime surgical care. Patient selection focused on salvageable limbs with an emphasis on functional outcomes. Decisions were made based on clinical assessment due to the lack of imaging and microbiology. Surgery followed a staged orthoplastic model: (1) triage and urgent debridement, (2) soft tissue coverage with local or regional flaps, (3) bone stabilisation, and (4) definitive reconstruction when possible. Debridement was meticulous and repetitive; delayed flaps were common due to operating room constraints. Alternative wound dressings—including sugar, vinegar, and Dakin's solution—were used in lieu of standard negative pressure therapy. External fixation was the primary stabilisation method. Results Despite limitations, limb salvage was achieved in a significant proportion of cases. Radical debridement and delayed coverage helped prevent systemic sepsis and allowed for eventual bone reconstruction. Functional outcomes varied, but many patients regained ambulatory ability. Challenges included late presentation, poor follow-up, limited implant availability, and high infection risk. Nonetheless, surgical adaptability and orthoplastic principles enabled meaningful outcomes even in high-risk cases. Notably, unconventional techniques—such as treating maggot-infested wounds with chlorine and sugar dressings—proved effective. Conclusion Orthoplastic strategies are highly adaptable to war zone contexts. While ideal protocols are often unachievable, the core principles—early debridement, appropriate fixation, and timely soft tissue coverage—remain central. Effective management relies on flexibility, innovation, and teamwork across surgical specialties. Sharing practical, experience-based approaches can guide others working in conflict zones, where conventional systems of care are absent. Ultimately, restoring function and dignity to trauma survivors in these settings is possible, even under the harshest conditions.