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Military inStep - A Publication of the Amputee Coalition in Partnership with the U.S. Army Amputee Patient Care Program. 2005.
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The Military Amputee and The Unique Characteristics of War Injuries

Wounding patterns that ocur with military injuries are very different from civilian injuries and greatly influence the way medical professionals manage any resulting amputations.

Military personnell and medical professionals

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.

 

Disclaimer: The views and opinions expressed in this publication are those of the authors and are not necessarily those of the Amputee Coalition, the Department of the Army, the Army Medical Department, or any other agency of the US Government.


Back to Top Last updated: 12/07/2014
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