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There is a very limited body of empirical research on blast-related injuries to extremities and subsequent limb salvage—much more research is needed

• An important gap is the absence of completed prospective, longitudinal studies with follow-up longer than one year.
• There is limited evidence on the outcomes of amputation versus limb salvage overall and in clinically relevant subgroups.
• Current evidence comparing various surgical approaches to limb salvage for blast-related limb injury is limited.
• The most underdeveloped area of empirical research pertains to rehabilitative approaches in caring for blast-injured patients with severe limb injuries. Promising programs have been identified, but codification and empirical evaluation are needed.

Severe limb injuries are common among combat-injured service members

• Persistent and disabling pain, sleep disturbance, depression and anxiety, and general loss of functioning are common after these injuries.
• Most service members with severe combat-related limb injury are significantly disabled.

There is no one-size-fits-all intervention for severe blast-related limb injuries

• To date, prognostic assessment tools have largely failed as decision aids for clinicians and patients.
• There is a need for ongoing, intensive efforts to share and study decisionmaking with patients, caregivers as appropriate, and a multidisciplinary clinical team.

During the conflicts in Iraq and Afghanistan, there have been changes in the mechanism, severity, and complexity of injuries from improvised explosive devices⁠—changes that have resulted in a higher incidence of combat-related traumatic injuries. Battlefield medical advances and improvements in protective equipment have resulted in a greater proportion of blast-exposed service members surviving their severe injuries, and progress in surgical reconstruction and rehabilitation has resulted in an increased medical capacity to salvage limbs. Collectively, these developments have led to important questions about when to emphasize limb salvage over other treatment options, most notably amputation, for individuals with severe blast-related limb injuries.

To better understand limb salvage and recovery after severe blast-related injury, the authors conducted a literature review of recent research on the topic. They considered completed research addressing one or more of four objectives: (1) injury epidemiology and outcomes; (2) the clinical decision to salvage the limb; (3) the process of limb restoration and reconstruction; and (4) rehabilitation, reintegration, and recovery strategies. They found that although there is a vast literature on limb salvage, there is limited research on military blast-related limb salvage. The authors make several recommendations related to future research into limb salvage and recovery after severe blast injury.

• Chapter One

  Background and Purpose

• Chapter Two

  Review Methodology

• Chapter Three

  Results

• Chapter Four

  Discussion and Recommendations

• Appendix A

  Planning Committee Members