Comparing the surgical timelines of military and civilians traumatic lower limb amputations

Abstract

The care and challenges of injured service have been well documented in the literature from a variety of specialities.The aim of this study was to analyse the surgical timelines of military and civilian traumatic amputees and compare the surgical and resuscitative interventions.A retrospective review of patient notes was undertaken. Military patients were identified from the Joint Theatre Trauma Registry (JTTR) in 2009. Civilian patients were identified using the hospital informatics database. Patient demographics, treatment timelines as well as surgical and critical care interventions were reviewed.In total 71 military patients sustained traumatic amputations within this time period. This represented 11% of the total injury demographic in 2009. Excluding upper limb amputees 46 patients sustained lower extremity amputations. These were investigated further. In total 21 civilian patients were identified in a 7-year period.Analysis revealed there was a statistically significant difference between patient age, ITU length of stay, blood products used and number of surgical procedures between military and civilian traumatic amputees. This study identified that military patients were treated for longer in critical care and required more surgical interventions for their amputations.Despite this, their time to stump closure and length of stay were not statistically different compared to civilian patients. Such observations reflect the importance of an Orthoplastic approach, as well as daily surgical theatre co-ordination and weekly multi-disciplinary meetings in providing optimal care for these complex patients. This study reports the epidemiological observed differences between two lower limb trauma groups.

Understanding Low Back Pain in Traumatic Lower Limb Amputees: A Systematic Review

“…Lower limb amputations are common during military or political conflicts, often caused by blast from improvised explosive devices. 72 , 73 These can be on the battlefield with military personnel, in events such as the Boston marathon bombing in April 2013 where athletes were injured, or in recent episodes of terrorist activities such as the bombings across Sri Lanka in April 2019. The commonality of these events is that often many young and healthy individuals have been hurt.…”

Overall Anatomic Severity and Prognosis in Patients Presenting with, or Requiring a Major Lower Limb Amputation from Civilian Trauma

“…On the other hand, published research on traumatic limb amputations related to civilian trauma are rare [5]. The only similar mechanism causing lower limb amputations (LLA) in civilians is explosions from terrorist attacks; many of these never reach the hospital alive [1]. Table 5 shows differences between train run-over and other mechanisms.…”

“…However, major limb amputations are rare in the civilian population, the largest numbers being seen in the military, often caused by explosive devices [2], and are considered to have, in general, a poorer prognosis, needing more aggressive treatments [1].…”

“…Studies in civilian trauma have demonstrated the importance of maintaining maximum length and performing infracondileal amputations rather than supracondileal, reporting better physical quality of life [4]. Unlike the military, the causes of lower limb amputation in the civilian population are diverse, often stemming from traumas resulting in multiple injuries, many of them life-threatening [1,5]. Lower limb amputations have been the topic of several studies by the military [2], but, to our knowledge, only one study has focused on the civilian population [5].…”

Prehospital emergency medicine – UK military experience

“…6 Unsurprisingly, the mean injury severity score of patients in recent conflicts has often been in excess of typical civilian trauma casualties. 7 It is speculated that the number of 'unexpected survivors' identified amongst UK casualties in the recent Afghanistan conflict is partly attributable to the adoption of this aggressive approach to the management of catastrophic haemorrhage.…”