Impact of extremity amputation on combat wounded undergoing exploratory laparotomy

Area of Science:

• Trauma Surgery
• Combat Medicine
• Surgical Critical Care

Background:

• Combat casualties with traumatic amputations (TA) and abdominal injuries pose unique clinical challenges.
• Exploratory laparotomy is often required for these severe injuries.

Purpose of the Study:

• To determine the association of TA with blood product usage, emergency department (ED) and operating room (OR) times, and mortality.
• To identify clinical indicators for increased resource utilization in combat trauma patients.

Main Methods:

• Retrospective study of 171 patients undergoing exploratory laparotomy for abdominal injury in Iraq.
• Patients were divided into two cohorts: with TA and without TA.
• Comparison of vital signs, laboratory values, blood product usage, ED/OR times, and mortality between groups.

Main Results:

• The TA cohort received more blood products and were more likely to require massive transfusion.
• No significant differences in mortality were observed between the TA and non-TA groups.
• TA patients had shorter ED times but longer OR times.

Conclusions:

• Traumatic amputations in penetrating abdominal injuries correlate with increased early blood product transfusions.
• Massive transfusion protocols should be initiated promptly upon identification of TA.
• Increased heart rate on admission was the primary indicator of injury severity; TA did not increase mortality.