Advances in medicine, protective equipment, and surgical reconstruction have led to questions about when to emphasize limb salvage over amputation for individuals with severe blast injuries. The authors summarize recent research on the topic.
This resource addresses all aspects of combat amputee care ranging from surgical techniques to long-term care, polytrauma and comorbidities such as traumatic brain injury and burns, pain management, psychological issues, physical and occupational therapy, VA benefits, prosthetics and adaptive technologies, sports and recreational opportunities, and return to duty and vocational rehabilitation.
Standards for the Management of Open Fractures provides an evidence-based approach for the management of open fractures, focussing on lower limb injuries. It builds on and expands the NICE Guidelines to provide a practical approach with supporting evidence. The new edition has been extensively updated and expanded to include key aspects of management, ranging from setting up an orthoplastic service, through to dealing with the bone and soft tissue injures, complications such as infection, and patient rehabilitation and psychological care. The book is primarily aimed at trainee plastic, orthopaedic and trauma surgeons (particularly for expanding knowledge and examination revision) but would also appeal to established surgeons to improve patient care. Standards for the Management of Open Fractures is an open access title. It is available to read and download as a free PDF version on Oxford Medicine Online. It has been made available under a Creative Commons Attribution-Non Commercial No Derivatives 4.0 International licence.
This practical and generously illustrated text presents the current concepts regarding the management of the mangled extremity, including microsurgery, vascular surgery, free tissue, nerve, hand, and replantation surgery. Since the advent of microsurgical reconstruction, significant progress has been made in the areas of replantation, free tissue transfer, as well as the refinement of skeletal fixation techniques. The scope will encompass the initial triage of a patient with a mangled upper or lower extremity, the initial and subsequent reconstructive efforts, to include skeletal fixation, vascular and soft tissue reconstruction, muscle and tendon transfers, psychological impact, therapy requirements, amputation considerations, and current data on salvage versus amputation in these scenarios. Case examples will be included to add further depth and context to the techniques and recommendations provided. Presenting these surgical challenges in detail, The Mangled Extremity will be an ideal resource for orthopedic and trauma surgeons, residents and fellows, as well as emergency surgeons facing these intense, traumatic injuries.
Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.
This book provides a practical guide to decision making within the realm of trauma surgery. Each chapter covers the ideal approach, rather than customary care, for the treatment of the chosen difficult decision or controversy. A broad range of topics are covered with particular attention given to resuscitation, wound management, thoracic and abdominal trauma, antimicrobial management, transplant considerations, vascular trauma, traumatic brain injury, pediatric trauma and ethics. Difficult Decisions in Trauma Surgery aims to help improve the treatment of trauma patients and is relevant to surgical trainees and practicing surgeons, and as well as medical professionals working within trauma medicine.
External fixation in Orthopedic traumatology is a textbook that focuses on the use of external fixation in the acute management of patients with serious orthopedic injuries. The book highlights the indications for external fixation and provides an evidenced based guide to both the specialist orthopedic surgeon and the trainee. The manuscript is organised in 15 chapters covering the indications and surgical techniques for pelvis, lower limb and upper limb injuries, including detailed illustrations and clinical photographs that will enable the reader to rapidly visualise the structure of the construct and to plan the surgery accordingly. More general topics such as damage control orthopedics, the biomechanics of external fixation and medico-legal considerations surrounding the injured patients are also included to provide an overall picture of the Orthopedic trauma patient. The Combined experience of the editors and authors, their involvement in a number of external fixation system designs and their international reputation in the field contribute to making this textbook an essential tool that should be available to all orthopedic surgeons dealing with injured patients.
"Dismounted Complex Blast Injury" (DCBI) is an explosion-induced battle injury sustained by a warfighter on foot patrol that produces a specific pattern of wounds. In particular, it involves traumatic amputation of at least one leg, a minimum of severe injury to another extremity, and pelvic, abdominal, or urogenital wounding. The US Army Surgeon General (SG) appointed a task force to study the causation, prevention, protection, treatment, and long-term care options of this BI pattern. This report will look at current candidates for "best practice" designation for prevention, mitigation, or treatment of dismounted complex blast injuries. It will address opportunities for intervention from the POI to long-term rehabilitation. The Task Force will address a systematic approach to this problem set from a medical perspective, using the Doctrine, Organization, Training, Materiel, Leadership, Personnel, Facilities and Contracting (DOTMLPF-C) approach, followed by specific recommendations for the way forward.