Surgeons bring battlefield experience home

By: Peter Pollack

By Peter Pollack

Physicians discuss care for wounded soldiers and civilians
“Approximately 31,000 U.S. service members have been wounded in Iraq and Afghanistan as a result of those wars,” explained Capt. Dana C. Covey, MD (U.S. Navy), chair of the department of orthopaedic surgery at the Naval Medical Center in San Diego. “Significantly, 60 to 70 percent of survivors have musculoskeletal injuries. The signature wound from this war has been explosive injuries, mostly by improvised explosive devices (IEDs).”

Orthopaedic surgeons are on the front lines of treating those injuries, as members of a media briefing panel made clear yesterday. Dr. Covey and other military and civilian surgeons covered topics ranging from casualty triage to the latest techniques in rehabilitation.

From left: Lt. Cmdr. William Krissoff, MD; Steven J. Morgan, MD; Maj. Eric Bluman, MD, PhD, and Col Mark W. Richardson, MD, were part of a media briefing on war injuries.

Col. Mark W. Richardson, MD (U.S. Air Force) discussed his experience serving at an Echelon III treatment center, which is the military equivalent of a Level 1 civilian trauma center.

“Iraqis and coalition service members receive basically the same quality of care,” said Dr. Richardson. “The difference is that U.S. soldiers are treated briefly so we can move them on to Germany. We’re doing what we call ‘damage control’ surgery. For the Iraqis, we do that same kind of initial care, and then we try to take them to completion—get the wounds closed or covered in some fashion. Triage in Iraq has nothing to do with nationality, or even which side of the fight you’re on. Whoever is most injured gets cared for first.”

New wound treatments
Maj. Eric M. Bluman, MD, PhD
(U.S. Army) provided an example of how orthopaedic research is helping save lives. He and his team have developed an improved subatmospheric wound dressing (SAWD). The advantages of SAWD include reducing wound fluid; clearing bacteria, dead tissue, and debris; and decreasing retraction of wound edges. However, the severity of war wounds can complicate the use of SAWD, and SAWD is of limited use during the transport process. Military surgeons developed an augmented SAWD, by sewing in the sponge to enhance conformity, adding adherent to minimize skin covered by plastic, and adding antibiotic beads to prevent infection. Results from a small pilot study showed that wounds treated with the augmented SWAD developed fewer infections and required no suction during transfer as compared to wounds treated with standard SAWD.

“We believe that continued research of these augmented dressings needs to be conducted,” said Dr. Bluman.

Melding civilian, military training
As the first civilian orthopaedic surgeon selected to travel to Landstuhl, Germany under the Visiting Orthopaedic Scholars Program, Steven J. Morgan, MD, brought the unique perspective of an experienced civilian trauma surgeon placed in a military setting. As a visiting scholar, Dr. Morgan led weekly lectures for the military surgeons for which they received continuing medical education credit; he also evaluated new patients and conducted surgery on U.S. military personnel.

“The ultimate benefit [of the program],” said Dr. Morgan, “is that we’ll be in a better position in the United States to deal with civilians who are injured by an act of terrorism, and ultimately, military personnel injured in the line of duty will benefit from the civilian collaboration.”

Life after tragedy
Inspired by the death of his 25-year-old son in a roadside bomb in Iraq and another son’s service in the Marines, Lt. Cmdr. William Krissoff, MD, exited his orthopaedic practice of 28 years to join the Naval Reserve at the age of 61. He explained that some of the bureaucratic restraints toward joining the armed forces late in life fell away after a meeting with President George W. Bush, and he received his commission on Nov. 17, 2007.

Christopher T. Born, MD, discussed his work at the Center for Restorative and Regenerative Medicine in Rhode Island. The center is helping to develop biohybrid limbs, which combine biologic and nonbiologic technologies to restore limbs that have been lost, particularly as a result of explosive devices. The Center is also working on transcutaneous osseointegrated devices, which integrate into the bone and allow the skin and soft tissue to grow around and integrate into the hardware; biomimetic prostheses, which use microprocessors to help the prosthesis adjust the feedback given to the wearer; and stem cell lines that can be generated from synovial tissue and used to develop cartilage.