title: Bilateral transfemoral/transtibial amputations due to battle injuries: a comparison of Vietnam veterans with Iraq and Afghanistan servicemembers.
abstract: BACKGROUND
  Multiple limb loss from combat injuries has increased as a proportion of all combat-wounded amputees. Bilateral lower-extremity limb loss is the most common, with bilateral transfemoral amputations being the most common subgroup followed by bilateral amputations consisting of a single transfemoral amputation and a single transtibial amputation (TFTT). With improvements in rehabilitation and prostheses, we believe it is important to ascertain how TFTT amputees from the present conflicts compare to those from the Vietnam War.
  
  
  OBJECTIVE
  We compared self-reported (1) health status, (2) quality of life (QoL), (3) prosthetic use, and (4) function level between TFTT amputees from the Vietnam War and Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF).
  
  
  METHODS
  As part of a larger survey, during 2007 to 2008, servicemembers with a diagnosis of amputation associated with battlefield injuries from the Vietnam War and OIF/OEF were identified from the Veterans Affairs and military databases. Participants were asked to respond to a questionnaire to determine their injuries, surgical history, presence of other medical problems, health status, QoL, function, and prosthetic use. We assessed QoL and health status using single-item questions and function using seven categories of physical activity. Thirteen of 298 (4.3%) participants in the Vietnam War group and 11 of 283 (3.8%) in the OIF/OEF group had sustained TFTT amputations. Mean age ± SD at followup was 61 ± 2 years and 28 ± 5 years for the Vietnam War and OIF/OEF groups, respectively.
  
  
  RESULTS
  Excellent, very good, and good self-reported health (85% versus 82%; p = 0.85) and QoL (69% versus 72%; p = 0.85) were similar between the Vietnam War and OIF/OEF groups, respectively. Level of function was higher in the OIF/OEF group, with four of 11 reporting participation in high-impact activities compared to none in the Vietnam War group (p = 0.018).
  
  
  CONCLUSIONS
  Participants with TFTT limb loss from both conflicts reported similar scores for QoL and health status, although those from OIF/OEF reported better function and use of prosthetic devices. It is unclear whether the improved function is from age-related changes or improvements in rehabilitation and prosthetics. Some areas of future research might include longitudinal studies of those with limb loss and assessments of physical function of older individuals with limb loss as the demographics shift to where this group of individuals becomes more prominent.
authors.affiliation: Department of Orthopedic Surgery, Detroit Receiving Hospital, 4201 St Antoine Street, Detroit, MI, 48201, USA, pdougher@dmc.org.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Dougherty
authors.forename: Lynne V
authors.initials: LV
authors.lastname: McFarland
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Smith
authors.forename: Gayle E
authors.initials: GE
authors.lastname: Reiber
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical / Q000379:methods* / Q000534:rehabilitation; D000674:Amputees / Q000534:rehabilitation; D001186:Artificial Limbs; D003430:Cross-Sectional Studies; D005269:Femur / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D054542:Iraq War, 2003-2011; D007869:Leg Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013977:Tibia / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014728:Veterans; D058014:Veterans Health; D047829:Vietnam Conflict; D055815:Young Adult