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DoD says amputations reached wartime high

Mar. 14, 2012 - 05:38AM   |   Last Updated: Mar. 14, 2012 - 05:38AM  |  
The X2 prosthetic allows amputees to navigate stairs with a normal gait.
The X2 prosthetic allows amputees to navigate stairs with a normal gait. (Army Medical Command)
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The number of U.S. troops who lost limbs reached a wartime high in 2011, according to data from the Defense Department, but along with the spike came advances in medicine and technology that have enabled troops with devastating wounds to survive and, in some cases, return to duty.

In 2011, 240 deployed troops had to have at least an arm or a leg amputated, compared with 205 in 2007, the height of the surge in Iraq, according to data published by the Armed Forces Health Surveillance Center.

The increase in 2011 coincides with the surge of troops in Afghanistan, who often dismount on foot patrols in the country's austere and rugged terrain.

Troops wounded in Afghanistan also have suffered the loss of multiple limbs — of the 187 service members with major limb loss in 2010, 72 of them lost more than one limb, according to the report from the Army's Dismounted Complex Blast Injury Task Force.

That's an increase from 2009, when of the 86 troops with major limb loss, 23 had multiple amputations, according to the task force's report.

The "most dramatic changes" in the wounds coming out of Afghanistan were the increased number of troops with above-the-knee amputation of both legs, triple and quadruple amputations, and the associated genital injuries, the task force reported.

The doctors and specialists who care for wounded warriors back home have seen a spike in amputees, but they also have been capitalizing on the latest research and technology to care for these wounded warriors, said John Shero, director of the Defense Department-Veterans Affairs Extremity Trauma and Amputation Center of Excellence.

The center, which was established by law in the 2009 Defense Authorization Act, is the lead DoD and VA organization for policy, direction and oversight of the care and study of amputations and extremity injuries.

"We want our wounded warriors to have the very best that we can get them," Shero said. "The very best technology, the very best care, the very best surgeons, to ensure they can get to the very best state of rehabilitation and return that they possibly can."

Lt. Col. (Dr.) Donald Gajewski, an orthopedic surgeon and director of the Center for the Intrepid at Fort Sam Houston, Texas, agreed.

"With this increase in patients, now we have a population of double and triple amputees, which is catastrophic, and each story is as heartbreaking as you can imagine, but our charge is to drive ourselves to see how we can … make their lives better," he said. "These guys who have catastrophic injuries, they push us to make them better."

The Center for the Intrepid is one of three DoD and seven VA amputee centers that fall under Shero's organization, including the Comprehensive Combat and Complex Casualty Care Center at Naval Medical Center San Diego, and the Military Advanced Training Center at Walter Reed National Military Medical Center in Bethesda, Md.

"We're providing world-class care to wounded warriors, and they are able to benefit from technology that doesn't exist elsewhere in the world," Shero said.

Advanced prosthetics

For example, the Army is testing a cutting-edge prosthetic known as the X3 that is currently not available to anyone else, Shero said. Made by German company Otto Bock, the X3 is the latest generation of the X2, which is a state-of-the-art, military-tailored prosthetic leg and knee that's powered by a microprocessor and designed for above-the-knee amputees.

"Four or five years ago, when the first microprocessor leg hit, we thought it was just amazing, and it was, and now we've developed two generations beyond that with the X2, and now the X3 is even more advanced," Shero said. "The technology is just phenomenal, and the X3 is not available to anyone else in the world at this point in time other than to our heroes."

The X2 and X3 evolved from the C-leg, which uses hydraulic cylinders to control the flexing of the knee.

"The C-leg became pretty standard practice for us, … and it allowed you to descend stairs and ramps without fear of the knee buckling under you," said John Fergason, the chief prosthetist at the Center for the Intrepid.

The C-leg costs the military between $18,000 and $20,000, he said.

The X2 is more rugged than the C-leg, and it was designed to meet certain military criteria, including the ability for the user to increase his activity in various terrains, Fergason said.

The X2 also allows users to walk up and down stairs with a normal gait, he said.

"It's become my knee of choice for sure," Fergason said. "In a traditional prosthetic, it's very difficult to go up stairs in a natural manner. Normally you lead with the good leg and use a nonbending prosthetic to go up the stairs to keep yourself safe. Now with the X2, you can use your body power to extend your knee and push yourself up the stairs like you would an anatomical knee."

The X2, which costs the military about $32,000 each, also allows the user to traverse obstacles, Fergason said.

The key advantage of the X3 is it is waterproof up to one meter for 10 minutes, he said.

"That's plenty of time to get you out of a wet situation," he said. "It doesn't mean you go float down the river with your knee submerged. It's meant for incidental water immersion. Up until now, submerging your knee was as absurd as jumping into the pool with your cellphone on your hip."

As of March 1, the Army is assessing and collecting feedback on the brand-new X3, Fergason said. He expects the prosthetic will go into production soon.

Apart from outfitting wounded troops with the most advanced prosthetics, the Army also has made advancements in limb salvage, Shero and Gajewski said.

"We have a whole bunch of research initiatives for extremity trauma and limb salvage and amputation care," Shero said. "We're not doing research that doesn't have an application. We're doing research to improve care for wounded warriors."

One of the key advancements made in limb salvage is the Intrepid Dynamic Exoskeletal Orthosis, or IDEO, which is a custom-made, custom-fitted carbon fiber device that's powered by the inert energy of the carbon fiber and the user's movements.

Designed and created at the CFI, the IDEO helps propel a service member's damaged leg, enabling him to walk and run, and giving hope to troops who are frustrated by the lack of progress with their damaged leg.

"We have those talks with patients all the time," Gajewski said. "There are limbs that are salvageable, but it's hard to have that conversation with the patient. Undergoing limb salvage is a long, long process, and some of the guys, before we had an option like the IDEO, they'd get frustrated and decide to amputate."

So far, the CFI has fitted more than 200 IDEOs, he said.

The Army and military continue to work hard to give wounded warriors the best possible care, Gajewski said.

"There are very few good things that come out of war, but the advancement of medicine is probably the most important thing," he said.

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