Amputation After Combat-Related Injuries: Advancements and Implications Published Dec. 4, 2014 Health.mil WASHINGTON -- during the Civil War, many soldiers faced considerable life-altering decisions when a limb had to be amputated. Amputees knew a very difficult path lay ahead for them, both physically and psychologically. More than 160 years later, American service members have medical technology and support groups that can make the path to recovery much smoother. "The advances we've made when it comes to treating war fighters who are severely wounded are impressive in terms of how we can quickly treat casualties and their wounds, and even now having the option of delaying amputation of mangled extremities," said Navy Cmdr. Mark Fleming, an orthopedic trauma surgeon from Walter Reed National Military Medical Center, during the Association of Military Surgeons of the United States (AMSUS) conference in Washington, D.C. "We also have teams of surgeons who are ready to provide the highest quality of critical care so we can ensure that people can have as normal a life as possible moving forward," Some of the most challenging cases involve pelvic fractures, Fleming said, as well injuries to the bladder and urethra, which are common. Initial focus should be on hemorrhage control and tissue preservation. After assessment of the wounds, a thorough survey of possible contamination is essential in order to reduce the risk of infection, Fleming told the audience. "The biggest challenge surgeons face is 'What should I do when treating a mangled extremity? Should I perform an amputation, or should I try to salvage this damaged limb?' " Fleming said. "It can be a very difficult decision at times, and sometimes a choice can be made for you, especially when you know an extremity may have a better functional outcome after being amputated." In addition to providing images of the various injuries that can lead to amputation, Fleming discussed how heterotopic ossification, the growth of bone in abnormal places such as soft tissue, plays a critical role in treating traumatic injuries. "Nearly a third of traumatic injuries we treat have this issue, which causes a decreased range in motion," Fleming said. Despite this complication, Fleming feels that given the advances medical research, heterotopic ossification is something that may be remedied in time through radiation therapy, anti-inflammatory agents, such as aspirin and ibuprofen, and mobilization techniques by physical therapists. Overall, the future for quickly treating traumatic injuries to extremities looks good, Fleming said, thanks to technological advances that enable surgeons to rapidly assess the necessity of an amputation and how to manage any associated complications. The presentation supported the general theme of AMSUS 2014, which centers on how the Military Health System is becoming more efficient in assessing and treating the health concerns of service members in all branches of the military, to make a more combat-ready force that can be rapidly-deployed.