{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T22:44:35Z","timestamp":1793573075151,"version":"4.5.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>The protracted Syrian conflict has devastated healthcare infrastructure across Syria with impacts on both the conflict and non-conflict related\u00a0surgical needs of patients. This review summarises the literature related to peripheral limb surgery performed in Syria between March 2011 to January 2024 to determine the influence of the conflict on surgical capacity and provision. A systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines was performed using six academic and one grey literature database. Studies that included clinical-epidemiological descriptions of procedures in orthopaedic, vascular and plastic surgery were included for quantitative and narrative analysis. The search resulted in 3951 papers, of which 7 met inclusion criteria. Studies varied widely in sample size (range:\u00a025\u20133835; total: 7749), design, and outcomes. Procedures spanned orthopaedic (1285, 31%), vascular (741, 18%), and plastic surgery (2145, 51%), totalling 4171 cases. Common procedures included wound management (51%), external fixation (26%), and lower limb amputation (15%). There was prevalence of emergency over elective surgery, performed in rudimentary, secret field hospitals by practitioners lacking formal specialist training or aid-workers. Inadequate documentation and incomplete data capture, due to the conflict, hindered the availability of high-quality, comprehensive surgical datasets within Syria. The focus on emergency surgery is a natural consequence of the prioritisation required with conflict-related pathology, however poor resource availability resulted in challenges in providing basic surgical care. Further research is needed to address gaps in evidence regarding the current state of surgery, training needs, and the quality of care provided.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004116","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T18:45:56Z","timestamp":1739213156000},"page":"e0004116","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Peripheral extremity surgery performed during the Syrian conflict \u2013 A scoping review"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3435-6251","authenticated-orcid":true,"given":"Anas","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4274-5489","authenticated-orcid":true,"given":"Usman","family":"Ammar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aula","family":"Abbara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Hariri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar","family":"Darwish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3600-4356","authenticated-orcid":true,"given":"Jude","family":"Alawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"issue":"9993","key":"pgph.0004116.ref001","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S0140-6736(15)60160-X","article-title":"Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development","volume":"386","author":"JG Meara","year":"2015","journal-title":"Lancet"},{"key":"pgph.0004116.ref002","unstructured":"The World Bank. Syrian Arab Rebublic Total Population. In: World Bank Open Data [Internet]. [cited 25 Feb 2024]. Available from: https:\/\/data.worldbank.org"},{"issue":"1","key":"pgph.0004116.ref003","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1186\/s12992-021-00762-9","article-title":"Public health consequences after ten years of the Syrian crisis: a literature review","volume":"17","author":"MHDBA Alhaffar","year":"2021","journal-title":"Glob Health"},{"issue":"10","key":"pgph.0004116.ref004","doi-asserted-by":"crossref","first-page":"3019","DOI":"10.1007\/s00268-021-06242-w","article-title":"The burden of surgical disease and access to care in a vulnerable Syrian refugee population in lebanon","volume":"45","author":"MK Moustafa","year":"2021","journal-title":"World J Surg"},{"key":"pgph.0004116.ref005","unstructured":"United Nations. Presentation of the report on civilian deaths in the Syrian Arab Republic. 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Surgical Specialty Associations","year":"2024"},{"key":"pgph.0004116.ref012","first-page":"215S\u2013227S","article-title":"The respective roles of plastic and orthopedic surgery in limb salvage","author":"OZ Lerman","year":"2011","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"pgph.0004116.ref013","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1308\/rcsbull.2015.445","article-title":"Role of plastic surgeons in major trauma centres in the UK","volume":"97","author":"T Wright","year":"2015","journal-title":"Bulletin"},{"key":"pgph.0004116.ref014","unstructured":"About Us. In: Syrian Board of Medical Specialties [Internet]. [cited 20 May 2024]. Available from: https:\/\/www.sboms.org\/en\/about-us\/"},{"key":"pgph.0004116.ref015","unstructured":"WHO EMRO | Syria earthquake | Priority areas | Syria site. [cited 20 May 2024]. 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