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Critical Concern for MHS: How Will Amputee Care Advances Be Sustained?

By U.S. Medicine

By Sandra Basu

WASHINGTON – How will the Military Health System maintain advances in limb and amputee care achieved over the last decade of war?

That is the question the Defense Health Board (DHB), an influential committee that advises the Secretary of Defense, is considering at the behest of DoD leadership.

“Really, the ball is in our court now for us to find a way to not only sustain but advance the superb and, as they say in a lot of cases, miraculous care of the current generation of warriors, both active and retired,” retired DHB member Gen. Frederick Franks Jr. said at the group’s meeting in June.

More than 1,600 amputees from the Iraq and Afghanistan wars have received care at military facilities since 2001. Franks told the DHB that future generations of amputees should “have the benefit of sustained skills from this war and also advancements as they are possible in the interwar years.”

The issue now faced by DoD is precisely how it will maintain currency and competency in amputee care and rehabilitation in an environment where there are fewer military amputee care and rehab patients, Joint Staff Surgeon Maj. Gen. Douglas Robb said during a DHB presentation.

“How are we going to keep up our skills in the inter-war years?” Robb asked.

Lance Cpl. Adrian Simone, an infantryman with 1st Battalion, 6th Marine Regiment, does pull-ups with Marines from his unit last year. Photo by Cpl. Jeff Drew

Paradigm Shift

During the past decade, there has been a paradigm shift as the type of amputee patients has changed from an older generation of veterans with advanced diabetes and other chronic problems to the current generation of amputees who are returning to high-performance occupations, Robb pointed out.

He said the expectation of recovery also is different now than before the recent conflicts. Advances in technology mean that troops who have lost limbs are not only walking with new prosthetics but are mobile in ways that once seemed impossible.

Many amputees have been able to return to active duty with prosthetic devices, and 68 have even redeployed back to Iraq or Afghanistan, according to the DoD-VA Extremity Trauma Amputation Center of Excellence.

“We would never have thought about this when we started this war … we have done an incredible job,” Robb noted.

The DHB review comes in response to a memo sent by acting under secretary of Defense Jessica L. Wright in June, directing the DHB to “review the full spectrum of amputee care, and define a strategy for preserving and continuing these advancements, identifying the best possible care to our beneficiaries.”

Her memo followed one by the Chairman of the Joint Chiefs of Staff Gen. Martin Dempsey.

In a memo to Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, Dempsey warned that the “anticipated reduction in war-related amputations may also be attended by the loss of knowledge and lessons learned that have brought us to the current level of capability.”

He further stated that “as such, sustaining current practices and continuing advancements in treatment and rehabilitation should be a high priority for the Defense Health Board.”


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