Multiple-limb war amputations on rise
azcentral.com | Mar 9th 2011
The majority of American soldiers undergoing amputations for war wounds last fall lost more than one limb, according to data presented Tuesday to the Defense Health Board, a committee of experts that advises the Defense Department on medical matters.
Military officials had previously released data showing that amputations, and especially multiple-limb losses, increased last year. The information presented to the 20-member board is the first evidence that the steepest increase occurred over the last four months of the year.
In September 2010, about two-thirds of all war-theater amputations involved a single limb (usually a leg), and one-third involved two or more limbs. The split was roughly 50-50 in October and November. In December, only one-quarter of amputation surgeries involved only one limb; three-quarters involved the loss of two or more limbs.
The Marines, who constitute 20 percent of forces in Iraq and Afghanistan, were hit especially hard. Of the 66 wounded severely enough to be evacuated from those countries in October, one-third lost a limb.
In the first seven years of the Iraq and Afghanistan wars, about 6 percent of seriously wounded soldiers underwent amputations.
Wounds to the genitals and lower-urinary tract, so-called genitourinary injuries, accounted for 11 percent of wounds over the last seven months of 2010, up from 4 percent in the previous 17 months, according to data presented by John Holcomb, a trauma surgeon and retired Army colonel.
The data were assembled by Holcomb and two physicians at Landstuhl Regional Medical Center in Germany, where seriously injured soldiers stop on their way back to the U.S.
The steep increase in both the rate and number of amputations clearly disturbed both Holcomb and members of the board, who met at a Hilton hotel near Washington.
Holcomb, a former head of the U.S. Army Institute of Surgical Research who spent two weeks at Landstuhl in December, said he had heard of "unwritten pacts among young Marines that if they get their legs and genitals blown off, they won't put tourniquets on but will let each other die on the battlefield."
Richard Carmona, who was U.S. surgeon general from 2002 to 2006 and is now on the board, said the information was "very disturbing."
He said it has made him ask: "What is the endgame here? Is the sacrifice we are asking of our young men and women worth the potential return? I have questions about that now."
Carmona, 61, served as an Army medic in Vietnam. He has a son who is an Army sergeant serving in Iraq.
Jay Johannigman, an Air Force colonel who has served multiple deployments as a trauma surgeon, said his stint at the military hospital at Bagram Airfield in Afghanistan last fall "was different" both personally and medically.
"We see the enormous price our young men and women are paying," he said. "It should not be for naught."
Why injuries requiring amputation increased so much in recent months isn't entirely understood. Some people have speculated that the mines may be constructed specifically to cause the devastating wounds.
"Do the Marines know? Probably," said Frank Butler, a physician and retired Navy captain who has spearheaded improvements in battlefield first aid over the past decade. "But they're not releasing a thing. And they shouldn't."
Original Page: http://www.azcentral.com/arizonarepublic/news/articles/2011/03/09/20110309military-amputations0309.html
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