When the Rubble Settles: Reconstructive Burden and Surgical Management of Multisite Injuries after the 2023 Türkiye Earthquakes

Earthquakes generate complex multisite soft-tissue injuries that may require prolonged reconstructive care beyond the initial casualty surge. The objective of this study was to characterize multisite injury patterns, reconstructive workload, time to complete definitive wound coverage, and early clinical outcomes among earthquake survivors referred to a tertiary reconstructive center after the 6 February 2023 Türkiye earthquakes. This retrospective observational cohort included 36 consecutive patients who underwent operative reconstructive management between February and December 2023. Demographics, anatomical involvement, procedures, amputation, wound microbiology, time to definitive coverage, and in-hospital outcomes were evaluated. Median age was 19.5 years (interquartile range, 10.0–33.0). Multisite injury was present in 34 patients (94.4%), with a median of four involved anatomical regions. Serial debridement was required in 33 patients (91.7%), skin grafting in 22 (61.1%), local flap reconstruction in six (16.7%), free tissue transfer in four (11.1%), and amputation in 15 (41.7%). Median time to complete definitive coverage was 34.5 days (interquartile range, 25.0-57.2), and 22 patients (61.1%) required more than 30 days. At least one of three selected Gram-negative wound organisms was isolated in 33 patients (91.7%); in-hospital mortality occurred in two (5.6%). Earthquake survivors requiring tertiary reconstructive care experienced a prolonged, multisite surgical burden extending beyond the initial casualty surge. Disaster preparedness should include sustained reconstructive capacity, repeated debridement and wound-bed preparation, definitive coverage, infection-control resources, and coordinated amputation and rehabilitation support.