The high kinetic energy delivered by modern
munitions causes extensive soft-tissue zones
of injury and results in wounds that are subject
to more complications and may take longer to
heal.
These munitions focus destructive forces
on the extremity, creating a particularly
complex wound with fragments of the
weapon and other debris driven into it. The
blast wave peels away the clothing or boot
and soft tissues. It also crushes bone and
strips it away, leaving exposed bone, a flap of
skin, and other soft tissue with debris forced
between planes (membranes that connect the
skin to the muscles) along the path of least
resistance.
This is not just a simple amputation, and
it has no real counterpart in civilian trauma.
Moreover, these injuries often have much
more soft-tissue damage than is initially
apparent, and failure to investigate the planes
or premature closure of the wounds can
inevitably lead to sepsis (multisystem organ
failure due to systemic infection) and the
need to re-amputate at a higher and often less
functional level. In addition, the munitions
used in military conflicts are capable of
causing extensive injury to multiple extremities
and the amputation of more than one limb.
Battlefield wounds are initially left open
because of the high risk of infection, and
a staged approach to amputation surgery
is necessary to obtain wound closure and
a residual limb that can provide the best
function. Because of the severe nature of
the wounds, reconstructive procedures are
often done later, even months or years after
the injury. If extensive soft-tissue or bone
procedures are done before the soft tissue
envelope has recovered and stabilized, there
is a higher risk of infection, failure and a repeat
amputation at a higher level.
Those injured by blasts may also have
mild to moderate traumatic brain injuries
(TBIs) along with their amputation. Such
injuries seem to result from the initial blast,
concussive effects within the skull, and
injury from the brain/skull complex hitting the
ground. Because of the unique characteristics
of war injuries, military psychologists perform
TBI testing to detect cognitive and other
deficits, which can affect each amputee’s
short- and long-term rehabilitation course.
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