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OBJECTIVES: While the incidence of casualties from the Global War on Terror is decreasing, there remains a focus on the long-term sequelae from injuries sustained in combat. Patients with prior significant limb injuries remain at risk for future complications. This study examines our institution’s experience with a multidisciplinary team approach toward this challenging patient population.
METHODS: All patients seen in a single institution Limb Preservation Clinic over a two year period were reviewed. Those patients who sustained a combat injury in theater were examined. Patient demographics, mechanism of injury, amputation rates, time to amputation, and reasons for failure were examined.
RESULTS: 94 patients were seen in our multidisciplinary Limb Preservation Clinic over a two year period. 20 patients (21%) were seen for combat-related injuries. 16 patients were evaluated and treated for chronic complications at a mean of 14 months from their injury. All 16 patients were male and the average age was 24 years. 10 patients (63%) sustained injuries secondary to a dismounted improvised explosive device (IED). All 16 patients had extensive soft tissue injuries and associated bone fractures. Only 3 patients (18%) had sustained a vascular injury. The average number of prior surgeries to the affected limb was 6. The limb salvage rate of 37% was lower than our non-combat cohort (47%). The most common reasons for amputation included chronic pain, osteomyelitis, and soft tissue infections.
CONCLUSIONS: The high amputation rates seen in this cohort underscores the need for long-term follow-up. Despite successful initial outcomes, many patients eventually progress to limb loss. Patients who sustain a dismounted IED are at greatest risk for a delayed amputation. Identifying and addressing those factors which lead to delayed amputation should be a priority for returning war veterans and focus of future studies.