title: Reoperations following combat-related upper-extremity amputations.
abstract: BACKGROUND
  Amputation revision rates following major upper-extremity amputations have not been previously reported in a large cohort of patients. We hypothesized that the revision rates following major upper-extremity amputation were higher than the existing literature would suggest, and that surgical treatment of complications and persistent symptoms would lead to improved outcomes.
  
  
  METHODS
  We performed a retrospective analysis of a consecutive series of ninety-six combat-wounded personnel who had sustained a total of 100 major upper-extremity amputations in Operation Iraqi Freedom and Operation Enduring Freedom. Prerevision and postrevision outcome measures, including prosthesis use and type, the presence of phantom and residual limb pain, pain medication use, and return to active military duty, were identified for all patients.
  
  
  RESULTS
  All amputations resulted from high-energy trauma, with 87% occurring secondary to a blast injury. Forty-two residual limbs (42%) underwent a total of 103 repeat surgical interventions. As compared with patients with all other levels of amputation, those with a transradial amputation were 4.7 (95% confidence interval [CI]: 1.75 to 12.46) times more likely to have phantom limb pain and 2.8 (95% CI: 1.04 to 7.39) times more likely to require neuropathic pain medications. In the group of patients who underwent revision surgery, regular prosthesis use increased from 19% before the revision to 87% after it (p < 0.0001).
  
  
  CONCLUSIONS
  In our cohort, revision amputation to address surgical complications and persistently symptomatic residual limbs improved the patient's overall acceptance of the prosthesis and led to outcomes equivalent to those following amputations that did not require revision.
authors.affiliation: Orthopaedic Surgery Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Tintle
authors.forename: Martin F
authors.initials: MF
authors.lastname: Baechler
authors.forename: George P
authors.initials: GP
authors.lastname: Nanos
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forsberg
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Potter
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects*; D000672:Amputation Stumps / Q000601:surgery; D001134:Arm Injuries / Q000601:surgery*; D001753:Blast Injuries / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008889:Military Personnel; D009999:Ossification, Heterotopic / Q000209:etiology; D010591:Phantom Limb / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery*; D055815:Young Adult