Photo Credit: Amos Ben Gershom/GPO
President Reuven Rivlin visits a Syrian civil war patient in a Nahariya hospital, April 09, 2017.

With the outbreak of the civil war in Syria ten years ago, Israel began admitting wounded Syrian nationals for humanitarian medical treatment. The IDF medical corps and hospitals in northern Israel have since provided medical treatment to thousands of wounded Syrians. The logistics of evacuating the injured from the battlefield and transferring them to Israeli territory was often prolonged because Israel and Syria are enemies.

Most of the wounded were brought to the Galilee Medical Center (GMC) in northern Israel. Some were admitted within 24 hours of their injury. For others, it took as long as 14 to 28 days to reach Israel from the combat zone.


The delay in the commencement of treatment offered medical professionals and researchers from GMC’s Ear, Nose, and Throat Ward and Department of Oral and Maxillofacial Surgery a rare window of opportunity to observe and evaluate how this lapse in time impacted the outcome of treatment.

In a study recently published in the journal Scientific Reports (The impact of delayed surgical intervention following high-velocity maxillofacial injuries), the researchers share their surprising observation that patients injured in the facial bones by high-speed projectiles and operated on approximately 2 to 4 weeks after the injury suffered fewer postoperative complications compared to the wounded who underwent immediate surgical treatment (within 72 hours).

The researchers hypothesize that this was due to a critical time before surgery, which facilitates healing and formation of new blood vessels in the area of the injury and, subsequently, an improvement in the blood and oxygen supply and a reduction in the incidence of complications.

Prof. Samer Srouji, member of the Azrieli Faculty of Medicine of Bar-Ilan University, the Chief of the Oral and Maxillofacial Institute at GMC and the lead author of the study, and his colleagues Daniel Oren, Amiel A. Dror, Adeeb Zoabi, Adi Kasem, Lior Tzadok, Fares Kablan, Nicole G. Morozov, Enssaf Safory, Eyal Sela, coined the term Critical Revascularization Period (CRP) to explain this phenomenon.

“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 Prof. 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 an artificial organ scaffold optimized for ideal oxygenation bone construction and rapid wound healing.”

Treating the wounded civilians also provided insight into injuries caused by sniper fire and high-velocity projectile injuries unique to a battlefield. The researchers developed a laboratory model that simulates shooting injuries and they continue to collect and process data from the period of treatment of the wounded from the Syrian civil war.

The findings in this study may lead to a reassessment of protocols for the treatment of high-speed projectile head and facial injuries. It is not yet possible to draw unequivocal conclusions concerning the ideal time for surgical treatment, however, the research findings indicate that delayed treatment, characterized by an opportunity for maxillofacial revascularization, can enhance surgical outcomes while simultaneously decreasing postoperative morbidity and complications.


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