The siege of Tripoli 1983: war surgery in Lebanon.

When Syrian-backed troops attacked the city of Tripoli and the surrounding Palestinian refugee camps in November and December 1983, the authors worked in the Palestine Red Crescent Society (PRCS) Hospital in the area. The hospital was situated close to the front line of the battle at all times and the transportation of casualties was therefore short. During the first month of the battle this hospital received approximately 1,500 casualties, and 390 primary and 24 secondary operations were performed. Multiple shrapnel wounds dominated, and high-velocity missile wounds were also frequently seen. The common treatment principles for missile wounds with radical debridement and delayed primary suture, in some cases secondary suture, were followed. Exploratory surgery was carried out in cases of suspected intra-abdominal and vascular injuries. Limited resources made an efficient selection necessary. Surgery under conditions of war is extremely demanding upon resources: equipment and personnel. By leaving minor debridements and a large amount of the emergency treatment to experienced nurses, a high capacity could be maintained.