US Department of Defense
BLAST INJURY RESEARCH
COORDINATING OFFICE
Advancing Blast Injury Research to Protect and Heal Those Who Serve

International State-of-the-Science Meeting On Limb Salvage and Recovery After Blast-Related Injury

In March 2019, the 8th Annual International State-of-the Science (SoS) Meeting, "Limb Salvage and Recovery After Blast-Related Injury", continued the legacy of the unique meeting series leveraging the expertise of outstanding scientists, engineers, and clinicians to identify knowledge gaps and inform future research needed to close the gaps in the prevention, mitigation, and treatment of blast injury. Read more.

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The meeting objectives were to:

  • Describe the epidemiology and outcomes of limb salvage after severe blast-related limb injury.
  • Review the evidence regarding the decision to salvage versus amputate a limb after severe blast-related limb injury.
  • Examine evidence and innovations regarding restoration and reconstruction after limb salvage for severe blast-related limb injury.
  • Review evidence and innovations regarding rehabilitation, reintegration and recover after limb salvage for severe blast-related limb injury.
  • Prioritize emerging research, technology, and policy gaps pertaining to limb salvage, restoration and recovery after severe blast-related limb injury.

Key Recommendations:

  1. Develop and disseminate a universal definition of trauma-related limb salvage
    To date, limb salvage is used for a wide range of scenarios and does not have a clear definition. The expert panel recommended creating, validating, and publishing a definition for trauma-related limb salvage and share it with organizations working with injured Service members.
  2. Recommend funding for randomized controlled trails of clinical care models and treatment studies involving large civilian-military consortia
    Additional interdisciplinary research is needed on the outcomes of amputation versus limb salvage. To help close this gap, the expert panel recommended establishing joint DoD-civilian Level 1 trauma centers to enroll civilians in prospective trials.
  3. Increase transparency of rehabilitation practices
    Current research comparing surgical approaches to limb salvage for blast-related injuries has been limited. Establishing centers of excellence for joint limb salvage and amputation military treatment facilities will break down barriers among therapeutic communities and specialists of parts of the anatomy. These centers and the external body that oversees them will ensure that evidence-based recommendations and best practices are shared and implemented.
  4. Improve physical support systems for limb salvage
    To improve the probability of securing funding for rehabilitative approaches, future studies should prioritize measuring the effectiveness of rehabilitation interventions. Additionally, researchers should clearly operationalize the outcomes they are measuring.
  5. Increase the number of trained surgeons on the front line
    Prolonged field-care scenarios present unique challenges and concerning gaps for limb salvage. The military does not currently have the surgical capacity on the front line and field medics are insufficiently trained for surgical care or anesthesia. To address these concerns, the military should invest in training for field medics, supportive technologies to improve outcomes, and additional front line surgeons.

The RAND Corporation will take the findings from the session and create a report that will help the Blast Injury Research Program Office identify scientific gaps and areas of research to focus on.

Last modified: 10-Jul-2020