Abstract
Introduction
The use of improvised explosive devices is a frequent method of insurgents to inflict
harm on deployed military personnel. Consequently, lower extremity injuries make up
the majority of combat related trauma. The wounding pattern of an explosion is not
often encountered in a civilian population and can lead to substantial disability.
It is therefore important to study the impact of these lower extremity injuries and
their treatment (limb salvage versus amputation) on functional outcome and quality
of life.
Patients and methods
All Dutch repatriated service members receiving treatment for wounds on the lower
extremity sustained in the Afghan theater between august 2005 and August 2014, were
invited to participate in this observational cohort study. We conducted a survey regarding
their physical and mental health using the Short Form health survey 36, EuroQoL 6
dimensions and Lower Extremity Functional Scale questionnaires. Results were collated
in a specifically designed electronic database combined with epidemiology and hospital
statistics gathered from the archive of the Central Military Hospital. Statistical
analyses were performed to identify differences between combat and non-combat related
injuries and between limb salvage treatment and amputation.
Results
In comparison with non-battle injury patients, battle casualties were significantly
younger of age, sustained more severe injuries, needed more frequent operations and
clinical rehabilitation. Their long-term outcome scores in areas concerning well-being,
social and cognitive functioning, were significantly lower. Regarding treatment, amputees
experienced higher physical well-being and less pain compared to those treated with
limb salvage surgery.
Conclusion
Sustaining a combat injury to the lower extremity can lead to partial or permanent
dysfunction. However, wounded service members, amputees included, are able to achieve
high levels of activity and participation in society, proving a remarkable resilience.
These long-term results demonstrate that amputation is not a failure for casualty
and surgeon, and strengthen a life before limb (damage control surgery) mindset in
the initial phase. For future research, we recommend the use of adequate coding and
injury scoring systems to predict outcome and give insight in the attributes that
are supportive for the resilience that is needed to cope with a serious battle injury.
Keywords
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Publication history
Published online: December 12, 2016
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