|
Abstract
|
BACKGROUND: 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: A retrospective review was performed on all patients treated in a single institution Limb Preservation Clinic over a two-year period. Those patients who sustained a combat-related injury in theater were examined. Patient demographics, mechanism of injury, amputation rates, time to amputation, and reasons for failure were examined.
RESULTS: Niney-four patients were evaluated in our multidisciplinary Limb Preservation Clinic over a two-year period. 20 patients (21%) were seen for combat-related injuries. Sixteen patients were evaluated and treated for chronic complications at a median of 13 months from their injury. All 16 patients were male with a median age of 24 years (range, 20-35). Ten patients sustained injuries secondary to a dismounted improvised explosive device (IED). All 16 patients had extensive soft tissue injuries and associated fractures. Only 2 patients sustained a vascular injury. The median number of prior surgeries to the affected limb was 8 (range, 3-19). The limb salvage rate of 37% was lower than our non-combat cohort (47%). The most common reasons for delayed amputation included chronic pain, osteomyelitis, and soft tissue infections.
CONCLUSION: The high secondary 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.
Language: en |