{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T04:17:45Z","timestamp":1789877865692,"version":"4.0.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"3-4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,20]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>As the combat operational tempo of the military conflicts in Iraq and Afghanistan has declined over the last decade, there has been a decrease in the number of patients requiring acute limb salvage. In their place, a growing population of patients with persistent functional deficits, pain, and inadequate soft tissue coverage stemming from prior limb salvage strategies have returned to our institution seeking revision surgery. Herein, we examine our institution\u2019s evolving surgical approach to extremity reconstruction from 2011 through 2019, culminating in the development of our limb restoration concept. We also discuss the impact of this orthoplastic approach on the acute management of complex extremity trauma and its role in providing sustained surgical readiness during interwar years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed all limb reconstructive procedures performed at our tertiary care military treatment facility between September 1, 2011 to December 31, 2019 to characterize the trends in extremity reconstruction procedures performed at our institution. Cases were identified as limb restoration procedures if they involved secondary\/revision reconstructive procedures designed to optimize function, treat pain, or improve the durability of the injured extremity following initial reconstruction efforts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nearly 500 limb restoration procedures were performed during the study period. These procedures steadily increased since 2011, reaching a maximum of 120 in 2018. Orthoplastic procedures such as osseointegration, targeted muscle reinnervation, regenerative peripheral nerve interface, agonist\u2013antagonist myoneural interface, and soft tissue resurfacing flap reconstruction accounted for the rise in secondary\/revision reconstruction performed during this time period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Limb restoration is a collaborative orthoplastic approach that utilizes state-of-the-art surgical techniques for treating complex extremity trauma. Although limb restoration originally developed in response to managing the long-term sequelae of combat extremity trauma, the concept can be adapted to the acute management setting. Moreover, limb restoration provides military surgeons with a means for maintaining critical war-time surgical skills during the current low casualty rate era.<\/jats:p>\n                    <jats:p>Level of Evidence: V, therapeutic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usab403","type":"journal-article","created":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T10:56:26Z","timestamp":1632999386000},"page":"e584-e590","source":"Crossref","is-referenced-by-count":7,"title":["Beyond Limb Salvage: Limb Restoration Efforts Following Remote Combat-Related Extremity Injuries Optimize Outcomes and Support Sustained Surgical Readiness"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2430-1399","authenticated-orcid":false,"given":"Sean M","family":"Wade","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin J","family":"Harrington","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin W","family":"Hoyt","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelica M","family":"Melendez-Munoz","sequence":"additional","affiliation":[{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin K","family":"Potter","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7757-2600","authenticated-orcid":false,"given":"Jason M","family":"Souza","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,9,30]]},"reference":[{"issue":"6","key":"2023033100473133200_","doi-asserted-by":"crossref","first-page":"341","DOI":"10.5435\/JAAOS-D-15-00123","article-title":"Musculoskeletal injuries in Iraq and Afghanistan: epidemiology and outcomes following a decade of war","volume":"24","author":"Belmont","year":"2016","journal-title":"J Am Acad Orthop Surg"},{"issue":"1","key":"2023033100473133200_","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1097\/PRS.0b013e3181904da9","article-title":"Lessons from operation Iraqi freedom: successful subacute reconstruction of complex lower extremity battle injuries","volume":"123","author":"Kumar","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"2023033100473133200_","first-page":"752","article-title":"Lessons from the modern battlefield: successful upper extremity injury reconstruction in the subacute period","volume":"67","author":"Kumar","year":"2009","journal-title":"J Trauma"},{"issue":"Suppl 1","key":"2023033100473133200_","doi-asserted-by":"crossref","first-page":"S74","DOI":"10.5435\/JAAOS-20-08-S74","article-title":"Extremity war injuries VII reconstruction panel. 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