DURING EVERY MAJOR CONFLICT, COMBAT INJURIES HAVE CAUSED LARGE NUMBERS OF SERVICE MEMBERS TO LOSE ONE OR MORE OF THEIR LIMBS; IN FACT, THESE INDIVIDUALS ARE ONE OF THE MOST VISIBLE AND ENDURING REMINDERS OF THE COST OF WAR.
During the Civil War, for example, approximately 21,000 major amputations occurred in the Union Army alone. Fortunately, since that time, there have been advances in medicine, prosthetics, and technology that have helped make it more possible for today’s war amputees to regain their independence and return to “normal” lives.
War Amputees in the Past
During World War I, there were 2,635 major amputations among American soldiers. By the time the United States became involved in World War II, the treatment of choice had become the open circular technique in which the wound was left open at the time of the initial surgery and the residual limb was placed in s09/07/2006ection in the postoperative period that occurred when the wound was prematurely closed. Soldiers were then transported to the United States from France and placed at amputee centers for wound healing, therapy and prosthetic fitting. In these centers, the resources of surgeons, prosthetists, nurses and therapists were consolidated and patients were treated by a team to provide consistent and comprehensive treatment. In fact, “the team approach,” commonly used today in the care of amputees, originated at this time. Lowerextremity amputees were fitted for a temporary prosthesis and allowed to ambulate.
There were about 15,000, U.S. Army amputees during World War II, and the early establishment of clinical policies by Major General N.T. Kirk, based on his experience during World War I, allowed for the best care of amputees during that war. In addition, Kirk helped establish amputee centers around the country to provide the specialized care that these individuals needed during World War I. In fact, during World War II, the U.S. Army established seven amputation centers, each with the capability to provide up-to-date surgical, medical, prosthetic and rehabilitative care.
Other significant advances were also made around this time. The National Research Council sponsored research on improving prosthetic devices. For lower-extremity amputees, basic gait was studied at the University of California in Berkeley to determine the parameters of normal gait to improve prosthetic function. The field of upper-extremity prosthetics was progressed/ advanced by a variety of companies, including Northrop Aircraft Corporation, in an effort to improve amputees’ ability to perform activities of daily living.
During the Korean War, improvements in resuscitation of severely injured patients, including amputees, reduced the mortality rate. Additionally, for the first time, it became practical to repair blood vessels injured in battle, reducing the amputation rate of blood vessel injuries from about 50 percent during World War II to about 10 percent when the vessels were repaired promptly.
By 1968, the number of amputees in military hospitals was growing because of the increased involvement of the United States in the Vietnam War. Amputees were cared for at Brooke Army General Hospital, Fitzsimmons Army General Hospital, Walter Reed General Hospital, Valley Forge Army General Hospital, and the U.S. Naval Hospitals in Oakland and Philadelphia.
The safety of leaving the residual limb open after amputation until patients were at a site of definitive care in the United States was reconfirmed by the high rate of complications seen with patients who had their wounds closed in Vie09/07/2006y ambulation of patients with lower-extremity amputations also appeared to be beneficial because it led to reduced swelling of the amputation wound, earlier independence, an improved psychological outlook, and the development of a faster proprioceptive sense.
War Amputees Today
Today, thousands of amputees continue to need specialized care as a result of their military service during conflicts such as those in Vietnam and more recently in southwest Asia. Providing this care remains a major challenge for the Armed Services during wartime and afterward as military amputees reenter the Service or return to civilian life and need long-term or lifelong support.
In general, lower-extremity amputations occur more frequently than upper-extremity amputations, and because of the nature of military operations, traumatic amputations due to blast, motor vehicle, and other injuries are more common among military Service members than their civilian counterparts. While civilian amputees are more likely to be older with one or more health problems, military amputees, like the military population in general, are typically young and healthy adults.
Traumatic military injuries are often different from injuries sustained in civilian life. The explosive force of modern munitions causes more tissue destruction than occurs in civilian injuries or occurred in military injuries in the past. At the same time, more war casualties survive these devastating injuries today largely because of advances in body armor, quicker access to advanced life support and effective technological care in the field, and our ability to more quickly transfer the injured over long distances to highly capable medical treatment facilities.
To prevent infection and preserve limb length, special surgical and medical techniques are required to manage blast-related wounds, which are often dirty and large. Sometimes, fragments from the blast itself may impair other soft tissue structures such as muscles and nerves, which can affect the overall rehabilitation and function of the new amputee. Frequently, the same blast that resulted in amputation can also result in a traumatic brain injury or concussion that can affect the service member’s personality, memory, or thinking. In addition, for months and perhaps years into the future, military Service members who are new traumatic amputees and their significant others will likely require a support network to help them adjust emotionally.
Out of necessity, the U.S. military has developed a rich tradition of addressing the special care needs of traumatic military amputees, and this tradition of readiness and leadership continues today.
Addressing the Needs of War Amputees
The vision of the Congress-supported U.S. Army Amputee Patient Care Program, which was established in December 2001, is to provide optimal, individualized care for active-duty amputees to maximize their physical, psychological, and emotional function. To accomplish these goals, the Program draws upon the best from both military and civilian experts in amputee care, and initiatives are under way to promote further advances in prosthetic technology. And since amputee care is lifelong care, there is also strong cooperation between the Department of Defense and the Department of Veterans Affairs (VA).
Today, the military continues to offer state-of-the-art amputee care and to help wounded service members regain their independence. Thanks to the high level of medical, prosthetic and technological care available in the military healthcare system, most of these young men and women will go on to live full and productive civilian lives or return to military duty if they so desire. We’ve made it our duty to provide them with every opportunity for a promising future.
In summary, the U.S. Army Amputee Patient Care Program is dedicated to providing expert and timely multidisciplinary amputee care to enable new military amputees to reach their highest level of function. And for those who have the desire and ability to continue their military service, the program is dedicated to offering the support they need to attain their goals.
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.
Image: Military man with upper-extremity amputation