Traumatic amputations

Abstract

Traumatic amputations remain one of the most emotionally disturbing wounds of conflict, as demonstrated by their frequent use in films to illustrate the horrors of war. Unfortunately, they remain common injuries, particularly following explosions, and, in addition, many survivors require primary amputation for unsalvageable injuries or to save their life. A third group, late amputations, is being increasingly recognised, often as a result of the sequelae of complex foot injuries. This article will look at the epidemiology of these injuries and their acute management, complications and outcome. KeywordsAcute pain, chronic pain, musculoskeletal pain, neuralgia, pain Key pointsTraumatic amputation remains very common following combat or terrorist wounding. With the significant advances in resuscitation, proximal and multiple amputations are being increasingly seen in survivors. As a result of the effects of the explosion, considerable tissue trauma occurs. Nerve injury is common and, with time, the functional level of the amputee will fall. These injuries remain a significant problem to health services following wars.

Social relationships in rehabilitation and their impact on positive outcomes among amputees with lower limb loss at Walter Reed National Military Medical Center

“…In the majority of explosive blast cases, injury results from a combination of the blast wave, fragment penetration and rapid bodily displacement. Compounding these immediate injuries to the extremities, blast injuries can, over time, lead to further tissue loss as well as infections in the residual limb, intact limbs, and other parts of the body (5,13). There is also the potential for extensive nerve damage, with almost onethird of Walter Reed's patients having nerve lesions and damage resulting in neuropathic pain and various levels of limited function (13,14).…”

“…Compounding these immediate injuries to the extremities, blast injuries can, over time, lead to further tissue loss as well as infections in the residual limb, intact limbs, and other parts of the body (5,13). There is also the potential for extensive nerve damage, with almost onethird of Walter Reed's patients having nerve lesions and damage resulting in neuropathic pain and various levels of limited function (13,14). Heterotopic ossification, uncomfortable bone formation at the site of amputation, is a common post-operative comorbidity associated with lower-limb amputations (5).…”

Amputation as a result of war injuries and terrorist attacks

“…Beşinci dekat önce, muharebe şartlarında yaralanma şekli mermi yaralanmasıyken, günümüzde patlamalara bağlı, yüksek basınçlı gazın patlama noktasından her yöne hızlı yayılması ve yarattığı blast etkiye bağlı yumuşak doku avulsiyonları meydana gelirken, ilk şok dalgasının yarattığı travmaya bağlı da kemik kırıkları oluşmak-tadır (8) (Resim 1). Ayrıca ekstremitelerin daha proksimalinde (blastın etkisi eklemleri de geçerek) düzensiz doku ezikleri ve hücre sarsıntı bölgeleri olmaktadır.…”

Imaging of Blast Injuries to the Lower Extremities Sustained in the Boston Marathon Bombing

“…Surgical intervention includes initial debridement and bony stabilization in the operating room. Surgeons should continue efforts to save the extremity whenever possible, but despite recent advances in extremity salvage techniques, amputation of the severely damaged portion of the lower extremity may be inevitable (Figures and ), particularly if the patient is physiologically unstable and critically ill (). Clinicians should be aware that lower extremity injury scoring systems should not be the sole criterion by which amputation decisions are made ().…”