Amputations within the army can occur in different contexts, some of them are:
- Severe limb injuries in which the efforts to save the limb fail, or the limb cannot be saved.
- Traumatic amputation (an unexpected amputation that occurs at the scene of an accident, where the limb is partially or entirely severed as a direct result of the accident)
- Bone infection (osteomyelitis) and/or diabetic foot infections
- Trench foot
- Meningococcal meningitis
- Vibrio vulnificus
- Necrotizing fasciitis
- Gas gangrene
- Influenza A Virus
- Animal bites
- Bubonic plague
Frostbite is a cold-related injury occurring when an area (typically a limb or other extremity) is exposed to extreme low temperatures, causing the freezing of the skin or other tissues. Its pathophysiology involves the formation of ice crystals upon freezing and blood clots upon thawing, leading to cell damage and cell death. Treatment of severe frostbite may require surgical amputation of the affected tissue or limb; if there is deep injury, autoamputation may occur.
Traumatic amputation is the partial or total avulsion of a part of a body during a serious accident, like traffic, labor, or combat. Traumatic amputation of a human limb, either partial or total, creates the immediate danger of death from blood loss.
Orthopedic surgeons often assess the severity of different injuries using the Mangled Extremity Severity Score. Given different clinical and situational factors, they can predict the likelihood of amputation. This is especially useful for emergency physicians to quickly evaluate patients and decide on consultations.
Private Lewis Francis was wounded July 21, 1861, at the First Battle of Bull Run by a bayonet to the knee.
Traumatic amputation is uncommon in humans (1 per 20,804 population per year). Loss of limb usually happens immediately during the accident, but sometimes a few days later after medical complications. Statistically, the most common causes of traumatic amputations are:
- Firearms, bladed weapons, explosives
- Vehicle accidents (cars, motorcycles, bicycles, trains, etc.)
- Labor accidents (equipment, instruments, cylinders, chainsaws, press machines, meat machines, wood machines, etc.)
- Agricultural accidents, with machines and mower equipment
- Electric shock hazards
- Violent rupture of ship rope or industry wire rope
- Ring traction (ring amputation, de-gloving injuries)
- Building doors and car doors
- Animal attacks
- Gas cylinder explosions
- Other rare accidents
The development of the science of microsurgery over the last 40 years has provided several treatment options for a traumatic amputation, depending on the patient’s specific trauma and clinical situation:
- 1st choice: Surgical amputation – break – prosthesis
- 2nd choice: Surgical amputation – transplantation of other tissue – plastic reconstruction.
- 3rd choice: Replantation- reconnection – revascularization of amputated limb, by microscope (after 1969)
- 4th choice: Transplantation of cadaveric hand (after 2000)
- In the United States in 1999, there were 14,420 non-fatal traumatic amputations according to the American Statistical Association. Of these, 4,435 occurred as a result of traffic and transportation accidents and 9,985 were due to labor accidents. Of all traumatic amputations, the distribution percentage is 30.75% for traffic accidents and 69.24% for labor accidents.
- The population of the United States in 1999 was about 300,000,000, so the conclusion is that there is one amputation per 20,804 persons per year. In the group of labor amputations, 53% occurred in laborers and technicians, 30% in production and service workers, 16% in silviculture and fishery workers.
- A study found that in 2010, 22.8% of patients undergoing amputation of a lower extremity in the United States were readmitted to the hospital within 30 days.
Methods in preventing amputation, limb-sparing techniques, depend on the problems that might cause amputations to be necessary. Chronic infections, often caused by diabetes or decubitus ulcers in bedridden patients, are common causes of infections that lead to gangrene, which would then necessitate amputation.
There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor blood circulation.
Crush injuries where there is extensive tissue damage and poor circulation also benefit from hyperbaric oxygen therapy (HBOT). The high level of oxygenation and revascularization speed up recovery times and prevent infections.
A study found that the patented method called Circulator Boot achieved significant results in prevention of amputation in patients with diabetes and arteriosclerosis. Another study found it also effective for healing limb ulcers caused by peripheral vascular disease. The boot checks the heart rhythm and compresses the limb between heartbeats; the compression helps cure the wounds in the walls of veins and arteries, and helps to push the blood back to the heart.
For victims of trauma, advances in microsurgery in the 1970s have made replantations of severed body parts possible. The establishment of laws, rules, and guidelines, and employment of modern equipment help protect people from traumatic amputations.
Common military injuries
- Amputations on the battlefield
- Blast or firearm amputations
- Collisions involving military vehicles
- Amputations caused by military equipment
- Cold weather amputations, including hypothermia and frostbite
- Hot weather amputations
- Falls (21.3%)
- Motor vehicle crashes (18.8%)
- Machinery or equipment accidents (12.6%)
- Blunt objects (10.8%)
- Gunshot wounds (7.1%)