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Published on: April 26, 2019
Amputation in military trauma surgery
Lynn G Stansbury1, Joanna G Branstetter, Steven J Lalliss
1Extremity Soft Tissue Branch, United States Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Insights
Major limb amputation, a severe combat injury, has seen reduced rates due to advancements in military trauma surgery. Modern techniques effectively manage hemorrhage, infection, and tissue loss, improving outcomes for wounded soldiers.
Area of Science:
- Military Medicine
- Trauma Surgery
- Surgical History
Background:
- Major limb amputations are debilitating combat injuries with significant public impact.
- This review examines the historical evolution of major limb amputation in military trauma surgery.
Observation:
- The utility of amputation for severe limb injuries has been historically recognized.
- Gunpowder's advent in the 14th century necessitated advancements in hemorrhage and sepsis control for amputation survival.
Findings:
- By the late 20th century, rapid evacuation and neurovascular repair minimized amputation necessity, reserving it for cases of extreme tissue loss.
- Military trauma surgeons have successfully addressed hemorrhage, infection, and neurovascular repair challenges over 500 years.
Implications:
- Despite being a fearsome outcome, amputation rates in military conflicts are at historic lows.
- Advances in trauma care have significantly improved outcomes for soldiers with severe limb injuries.
Background:
Major limb amputations are among the most debilitating wounds sustained by those who survive a combat injury and these injuries leave a lasting impression with the public. This article will review the history of major limb amputation in military trauma surgery.
Methods:
Review of published historic and modern battle casualty information was undertaken in the collections of the medical library of the National Naval Medical Center and the National Library of Medicine, both in Bethesda, Maryland, and the University of Maryland Health Sciences Center in Baltimore, Maryland.
Results:
The potential utility of major limb amputation as a life-saving surgical intervention for compound fractures and other devastating limb injuries has been recognized through much of written human history. However, the advent of gunpowder onto the battlefields of Europe in the 14th century forced surgeons to solve the problems of, first, hemorrhage and then, as casualties survived the initial surgery, sepsis for amputation to actually improve outcomes. In the latter half of the 20th century, rapid evacuation from the battlefield and successful neurovascular repair has reduced the need for major limb amputations essentially for those required by insurmountable tissue loss.
Conclusions:
Major limb amputation remains a fearsome outcome of limb injury. However, during the last 500 years, military trauma surgeons have solved the problems of bleeding, infection, and neurovascular repair after major limb injury such that amputation rates even during times of active military conflict are at historic lows.
