title: Outcomes after long-term follow-up of combat-related extremity injuries in a multidisciplinary limb salvage clinic.
abstract: BACKGROUND
  Although the incidence of casualties from the Global War on Terror is decreasing, there remains a focus on the long-term sequelae from injuries sustained in the combat. Patients with prior significant limb injuries remain at risk of future complications. This study examines our institution's experience with a multidisciplinary team approach toward this challenging patient population.
  
  
  METHODS
  A retrospective review was performed on all patients treated in a single institution Limb Preservation Clinic over a 2-year period. Those patients who sustained a combat-related injury in theater were examined. Patient demographics, mechanism of injury, amputation rates, time to amputation, and reasons for failure were examined.
  
  
  RESULTS
  Ninety-four patients were evaluated in our multidisciplinary Limb Preservation Clinic over a 2-year period. Twenty patients (21%) were seen for combat-related injuries. Sixteen patients were evaluated and treated for chronic complications at a median of 13 months from their injury. All 16 patients were male with a median age of 24 years (range, 20-35). Ten patients sustained injuries secondary to a dismounted improvised explosive device (IED). All 16 patients had extensive soft tissue injuries and associated fractures. Only 2 patients sustained a vascular injury. The median number of prior surgeries to the affected limb was 8 (range, 3-19). The limb salvage rate of 37% was lower than our noncombat cohort (47%). The most common reasons for delayed amputation included chronic pain, osteomyelitis, and soft tissue infections.
  
  
  CONCLUSIONS
  The high secondary amputation rates seen in this cohort underscores the need for long-term follow-up. Despite successful initial outcomes, many patients eventually progress to limb loss. Patients who sustain a dismounted IED are at greatest risk for a delayed amputation. Identifying and addressing those factors which lead to delayed amputation should be a priority for returning war veterans and focus of future studies.
authors.affiliation: Department of General Surgery, Division of Vascular Surgery, Naval Medical Center San Diego, San Diego, CA. Electronic address: kevin.casey@med.navy.mil.
authors.forename: Kevin
authors.initials: K
authors.lastname: Casey
authors.affiliation: Department of General Surgery, Division of Vascular Surgery, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Demers
authors.affiliation: Department of General Surgery, Division of Vascular Surgery, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Sophia
authors.initials: S
authors.lastname: Deben
authors.affiliation: Department of General Surgery, Division of Vascular Surgery, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Meghann E
authors.initials: ME
authors.lastname: Nelles
authors.affiliation: Department of General Surgery, Division of Vascular Surgery, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Weiss
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D001753:Blast Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002140:California; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D018450:Disease Progression; D005107:Explosions; D005121:Extremities / Q000098:blood supply*; D050723:Fractures, Bone / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006772:Hospitals, Military; D006801:Humans; D033183:Interdisciplinary Communication; D023821:Limb Salvage / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010348:Patient Care Team; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014857:Warfare; D055815:Young Adult