“Send the Marines”: Reconstructive Surgery at the Edge of Manageability

Across domains as different as war and medicine, escalation occurs not when systems function smoothly, but when they reach the limits of protocol. The military phrase "Send the Marines" names a readiness to enter uncertainty, scarcity, and moral burden when conventional solutions fail. A comparable reflex exists in trauma care, where plastic and reconstructive Surgery is often consulted late, after survival has been secured, but closure-anatomical, functional, and symbolic-remains unresolved. This editorial reflects on the parallels between Marines and reconstructive surgeons as professionals defined less by technical perfection than by endurance, improvisation, and responsibility in irreducibly complex situations. By situating reconstructive surgery at the margins of manageability, the essay argues that its deepest task is not merely to repair tissue, but to preserve identity, dignity, and continuity of self when damage resists resolution.