@article{ref1,
title="Outcomes after long-term follow-up for combat-related extremity injuries in a multidisciplinary limb salvage clinic",
journal="Annals of vascular surgery",
year="2015",
author="Casey, Kevin and Demers, Pamela and Deben, Sophia and Nelles, Meghann E. and Weiss, Jeffrey S.",
volume="29",
number="3",
pages="496-501",
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. <br><br>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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0890-5096",
doi="10.1016/j.avsg.2014.09.035",
url="http://dx.doi.org/10.1016/j.avsg.2014.09.035"
}