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Definitive Treatment of Combat Casualties at Military Medical Centers

Dr. Andersen is Director, Orthopaedic Traumatology, National Naval Medical Center, Bethesda, MD; Staff Orthopaedic Surgeon, Walter Reed Army Medical Center, Washington, DC; and Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Bethesda. Dr. Frisch is Director, Orthopaedic Traumatology, Walter Reed Army Medical Center, and Assistant Professor of Surgery, Uniformed Services University of the Health Sciences. Dr. Farber is Director, Hand Surgery, Walter Reed Army Medical Center, and Assistant Professor of Surgery, Uniformed Services University of the Health Sciences. Dr. Hayda is Director, Residency Program, Director, Orthopaedic Surgery, and Chief, Orthopaedic Trauma, Brooke Army Medical Center, San Antonio, TX; and Assistant Professor of Surgery, Uniformed Services University of the Health Sciences.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Andersen, Dr. Frisch, Dr. Farber, and Dr. Hayda. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense, nor the U.S. Government.

More than 9,000 casualties have been evacuated during the current conflict, and more than 40,000 orthopaedic surgical procedures have been performed. The most severely injured patients are treated in the United States at military medical centers. Individualized reconstructive plans are developed, and patients are treated with state-of-the-art techniques. Rehabilitation includes the assistance of the physical medicine and rehabilitation, physical therapy, and occupational therapy services, as well as, when necessary, psychiatric or other services. The extreme challenges of treating war-related soft-tissue defects include neurovascular injuries, burns, heterotopic ossification, infection, prolonged recovery, and persistent pain. Such injuries do not allow full restoration of function. Because of such devastating injuries, and despite use of up-to-date methods, outcomes can be less than optimal.

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