Reconstructive and prosthetic options for the wounded warrior

Abstract

A recent estimate of wounded from the Afghanistan war is close to 17,000 and from the Iraq war over 30,000. Extremity trauma is the one of the hallmark injuries from these conflicts. The long-term effects of this number of extremity-injured patients on our military and civilian health care systems is unknown. The relative severity, if amputation rate can be used as a surrogate, is significantly higher than in civilian trauma. In this article, we discuss the most current management strategies used in these complex patients and the myriad of lower extremity disease they experience. We also discuss a new “standard” for patients with severe lower extremity trauma. Previous expectations were to return patients to their preinjury level of function with limb retention. Now, the new expectation of this group of patients is to recover in a time frame and function level equivalent to a below knee amputee, which is a more accelerated course. Several advances have been made in an effort to offer similar functional results to these severely injured patients to include the gradual expansion muscle (GEM) flap, which corrects soft-tissue defects as well skeletal defects without the use of free-tissue transfer. Another significant advance is the Intrepid Dynamic Exoskeleton Orthosis (IDEO), which is a plantarflexion powered carbon fiber ankle-foot orthosis that allows patients with limb salvage the opportunity to return to high-impact activities. Other germane topics reviewed include management of calcaneal fractures with severe soft-tissue injury, partial foot amputations, and elective amputations for the indication of pain.