High Bilateral Amputations and Dismounted Complex Blast Injury (DCBI)

Area of Science:

• Trauma Surgery
• Military Medicine
• Emergency Medicine

Background:

• High, combat-related bilateral lower extremity amputations often indicate multisystem injuries.
• Dismounted complex blast injury (DCBI) is a life-threatening condition resulting from improvised explosive devices.
• Prompt intervention is critical for survival and mitigating complications.

Purpose of the Study:

• To outline the essential components of damage control resuscitation and surgery for DCBI.
• To emphasize the importance of a coordinated team approach in managing these severe injuries.
• To highlight strategies for improving patient survival and functional outcomes.

Main Methods:

• Rapid damage control resuscitation, including airway management and volume resuscitation (whole blood or ratio transfusion).
• Immediate control of life-threatening hemorrhage, potentially involving aortic or iliac vessel clamping.
• Surgical management including pelvic fracture stabilization, wound debridement, and provisional fracture stabilization.

Main Results:

• The primary goal is to rapidly control hemorrhage and avoid the lethal triad of acidosis, hypothermia, and coagulopathy.
• Utilization of multiple surgical teams is recommended for concurrent hemorrhage control.
• Ongoing resuscitation and frequent returns to the operating suite are necessary throughout patient evacuation.

Conclusions:

• A coordinated, multidisciplinary team approach is essential for managing DCBI.
• Early and aggressive damage control resuscitation and surgery significantly improve survival rates.
• This approach can lead to reasonable functional outcomes despite the severity of injuries.