During the Civil War, for example, approximately
21,000 major amputations occurred in the Union
Army alone. Fortunately, since that time, there
have been advances in medicine, prosthetics,
and technology that have helped make it more
possible for today’s war amputees to regain
their independence and return to “normal” lives.
War Amputees in the Past
During World War I, there were 2,635 major
amputations among American soldiers. By
the time the United States became involved
in World War II, the treatment of choice had
become the open circular technique in which
the wound was left open at the time of the
initial surgery and the residual limb was placed
in s09/07/2006ection in the postoperative period that
occurred when the wound was prematurely
closed. Soldiers were then transported to
the United States from France and placed at
amputee centers for wound healing, therapy
and prosthetic fitting. In these centers, the
resources of surgeons, prosthetists, nurses and
therapists were consolidated and patients were
treated by a team to provide consistent and
comprehensive treatment. In fact, “the team
approach,” commonly used today in the care
of amputees, originated at this time. Lowerextremity
amputees were fitted for a temporary
prosthesis and allowed to ambulate.
There were about 15,000, U.S. Army
amputees during World War II, and the early
establishment of clinical policies by Major
General N.T. Kirk, based on his experience
during World War I, allowed for the best care
of amputees during that war. In addition, Kirk
helped establish amputee centers around
the country to provide the specialized care
that these individuals needed during World
War I. In fact, during World War II, the U.S.
Army established seven amputation centers,
each with the capability to provide up-to-date
surgical, medical, prosthetic and rehabilitative
care.
Other significant advances were also made
around this time. The National Research Council
sponsored research on improving prosthetic
devices. For lower-extremity amputees, basic
gait was studied at the University of California in
Berkeley to determine the parameters of normal
gait to improve prosthetic function. The field of
upper-extremity prosthetics was progressed/
advanced by a variety of companies, including
Northrop Aircraft Corporation, in an
effort to improve amputees’ ability to
perform activities of daily living.
During the Korean War,
improvements in resuscitation of
severely injured patients, including
amputees, reduced the mortality rate.
Additionally, for the first time, it became
practical to repair blood vessels injured
in battle, reducing the amputation rate
of blood vessel injuries from about 50
percent during World War II to about
10 percent when the vessels were
repaired promptly.
By 1968, the number of amputees in
military hospitals was growing because
of the increased involvement of the
United States in the Vietnam War.
Amputees were cared for at Brooke
Army General Hospital, Fitzsimmons
Army General Hospital, Walter Reed
General Hospital, Valley Forge Army
General Hospital, and the U.S. Naval
Hospitals in Oakland and Philadelphia.
The safety of leaving the residual
limb open after amputation until
patients were at a site of definitive care
in the United States was reconfirmed
by the high rate of complications seen
with patients who had their wounds
closed in Vie09/07/2006y ambulation
of patients with lower-extremity
amputations also appeared to be
beneficial because it led to reduced
swelling of the amputation wound,
earlier independence, an improved
psychological outlook, and the
development of a faster proprioceptive
sense.
War Amputees Today
Today, thousands of amputees continue
to need specialized care as a result of
their military service during conflicts
such as those in Vietnam and more
recently in southwest Asia. Providing
this care remains a major challenge for
the Armed Services during wartime and
afterward as military amputees reenter
the Service or return to civilian life and
need long-term or lifelong support.
In general, lower-extremity
amputations occur more frequently
than upper-extremity amputations,
and because of the nature of military
operations, traumatic amputations
due to blast, motor vehicle, and other
injuries are more common among
military Service members than their
civilian counterparts. While civilian
amputees are more likely to be older
with one or more health problems,
military amputees, like the military
population in general, are typically
young and healthy adults.
Traumatic military injuries are often
different from injuries sustained in
civilian life. The explosive force of
modern munitions causes more tissue
destruction than occurs in civilian
injuries or occurred in military injuries in
the past. At the same time, more war
casualties survive these devastating
injuries today largely because of
advances in body armor, quicker access
to advanced life support and effective
technological care in the field, and
our ability to more quickly transfer the
injured over long distances to highly
capable medical treatment facilities.
To prevent infection and preserve
limb length, special surgical and
medical techniques are required to
manage blast-related wounds, which
are often dirty and large. Sometimes,
fragments from the blast itself may
impair other soft tissue structures
such as muscles and nerves, which
can affect the overall rehabilitation
and function of the new amputee.
Frequently, the same blast that resulted
in amputation can also result in a
traumatic brain injury or concussion
that can affect the service member’s
personality, memory, or thinking. In
addition, for months and perhaps
years into the future, military Service
members who are new traumatic
amputees and their significant others
will likely require a support network to
help them adjust emotionally.
Out of necessity, the U.S. military has
developed a rich tradition of addressing
the special care needs of traumatic
military amputees, and this tradition
of readiness and leadership continues
today.
Addressing the Needs
of War Amputees
The vision of the Congress-supported
U.S. Army Amputee Patient Care
Program, which was established in
December 2001, is to provide optimal,
individualized care for active-duty
amputees to maximize their physical,
psychological, and emotional function.
To accomplish these goals, the
Program draws upon the best from
both military and civilian experts in
amputee care, and initiatives are under
way to promote further advances
in prosthetic technology. And since
amputee care is lifelong care, there
is also strong cooperation between
the Department of Defense and the
Department of Veterans Affairs (VA).
Today, the military continues to offer
state-of-the-art amputee care and
to help wounded service members
regain their independence. Thanks to
the high level of medical, prosthetic
and technological care available in the
military healthcare system, most of
these young men and women will go
on to live full and productive civilian
lives or return to military duty if they
so desire. We’ve made it our duty to
provide them with every opportunity for
a promising future.
In summary, the U.S. Army Amputee
Patient Care Program is dedicated
to providing expert and timely
multidisciplinary amputee care to
enable new military amputees to reach
their highest level of function. And for
those who have the desire and ability
to continue their military service, the
program is dedicated to offering the
support they need to attain their goals.
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