{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T06:56:54Z","timestamp":1777013814416,"version":"3.51.4"},"reference-count":18,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DoD-VA Extremity Trauma and Amputation Center of Excellence","award":["HU00012020038"],"award-info":[{"award-number":["HU00012020038"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: This study examined the incidence of acute complications within the first year following combat-related lower extremity injuries in United States (U.S.) Service members (SMs). The research compared outcomes between primary amputation (PA), limb salvage (LS), and non-threatening limb trauma (NTLT) groups, and conducted a subgroup analysis within the LS group, differentiating between SM who underwent a secondary amputation (LS-SA) and those who did not (LS-NA). Methods: A retrospective analysis of combat-related lower extremity injuries sustained between January 2001 and October 2015 was performed using data from the Military Health System Medical Data Repository. Chi-square tests and adjusted logistic regression analysis were used to compare complication frequencies by injury severity. Results: The analysis of the 4275 SM revealed that 21% had undergone PA, 47% LS (with 13% experiencing LS-SA and 87% LS-NA), and NTLT was observed in 32% of cases. The PA group exhibited higher rates of most acute complications compared to other groups, with three exceptions\u2014i.e., non-union fractures, compartment syndrome, and orthopedic device complications were more prevalent in the LS group than the PA group. The LS-SA group had higher complication rates than the LS-NA group for most complications. Notably, the PA group was associated with the highest rates of post-hemorrhagic anemia and heterotopic ossification, while the LS-SA group exhibited the highest rates of osteomyelitis, non-union fractures, non-healing wounds, and compartment syndrome. Conclusions: Individuals with amputation (PA or LS-SA) were more likely to experience acute complications compared to their counterparts (PA vs. LS and NTLT; LS-SA vs. LS-NA), with the exception of non-union fractures, which were more frequent in the LS group than the PA group. These findings highlight the need for close monitoring and targeted interventions to address post-surgical complications in Service members with limb salvage.<\/jats:p>","DOI":"10.3390\/jcm14113923","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T06:21:51Z","timestamp":1748931711000},"page":"3923","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute Complications of United States Service Members with Combat-Related Lower Extremity Limb Salvage"],"prefix":"10.3390","volume":"14","author":[{"given":"Susan L.","family":"Eskridge","sequence":"first","affiliation":[{"name":"Leidos, San Diego, CA 20190, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3537-3127","authenticated-orcid":false,"given":"Aidan","family":"McQuade","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen M.","family":"Goldman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"},{"name":"Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher L.","family":"Dearth","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"},{"name":"Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1097\/BOT.0b013e31802f78fb","article-title":"Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom","volume":"21","author":"Owens","year":"2007","journal-title":"J. Orthop. Trauma"},{"key":"ref_2","first-page":"2","article-title":"Epidemiology of combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom: Orthopaedic burden of disease","volume":"19","author":"Belmont","year":"2010","journal-title":"J. Surg. Orthop. Adv."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1001\/jamasurg.2019.0151","article-title":"Use of Combat Casualty Care Data to Assess the US Military Trauma System During the Afghanistan and Iraq Conflicts, 2001\u20132017","volume":"154","author":"Howard","year":"2019","journal-title":"JAMA Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1097\/MCC.0000000000001108","article-title":"Mangled extremity: Limb salvage for reconstruction versus primary amputation","volume":"29","author":"Tjardes","year":"2023","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_5","first-page":"9","article-title":"Changing paradigms in lower extremity reconstruction in war-related injuries","volume":"3","author":"Connolly","year":"2016","journal-title":"Mil. Med. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e0170569","DOI":"10.1371\/journal.pone.0170569","article-title":"A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage","volume":"12","author":"Melcer","year":"2017","journal-title":"PLoS ONE"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Goldman, S.M., Eskridge, S.L., Franco, S.R., Souza, J.M., Tintle, S.M., Dowd, T.C., Alderete, J., Potter, B.K., and Dearth, C.L. (2023). A Data-Driven Method to Discriminate Limb Salvage from Other Combat-Related Extremity Trauma. J. Clin. Med., 12.","DOI":"10.3390\/jcm12196357"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Goldman, S.M., Eskridge, S.L., Franco, S.R., and Dearth, C.L. (2023). Demographics and Comorbidities of United States Service Members with Combat-Related Lower Extremity Limb Salvage. J. Clin. Med., 12.","DOI":"10.3390\/jcm12216879"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/BOT.0b013e31818e43dd","article-title":"Complications following limb-threatening lower extremity trauma","volume":"23","author":"Harris","year":"2009","journal-title":"J. Orthop. Trauma"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/BOT.0b013e31802cbc43","article-title":"Complex Limb Salvage or Early Amputation for Severe Lower-Limb Injury: A Meta-Analysis of Observational Studies","volume":"21","author":"Busse","year":"2007","journal-title":"J. Orthop. Trauma"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/SAP.0b013e3181cbfcce","article-title":"A Decision Analysis of Amputation Versus Reconstruction for Severe Open Tibial Fracture from the Physician and Patient Perspectives","volume":"66","author":"Chung","year":"2011","journal-title":"Ann. Plast. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1097\/TA.0b013e318221181d","article-title":"Infectious Complications and Soft Tissue Injury Contribute to Late Amputation After Severe Lower Extremity Trauma","volume":"71","author":"Huh","year":"2011","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4961","DOI":"10.1007\/s00402-023-04804-2","article-title":"Limb salvage versus primary amputation in Gustilo-Anderson IIIB and IIIC tibial fractures: A systematic review and meta-analysis","volume":"143","author":"Ng","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S247","DOI":"10.1097\/TA.0b013e318299d95e","article-title":"A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars","volume":"75","author":"Melcer","year":"2013","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"569","DOI":"10.52628\/88.3.6600","article-title":"Limb salvage results of Gustilo IIIC fractures of the lower extremity","volume":"88","author":"Ozmen","year":"2022","journal-title":"Acta Orthop. Belg."},{"key":"ref_16","first-page":"1241","article-title":"Combat versus civilian open tibia fractures: The effect of blast mechanism on limb salvage","volume":"70","author":"Doucet","year":"2011","journal-title":"J. Trauma"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1016\/j.jvs.2013.12.037","article-title":"Comparison of military and civilian popliteal artery trauma outcomes","volume":"59","author":"Doucet","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/smi.3271","article-title":"Assessing the physiological basis for resilience in military personnel","volume":"39","author":"McClung","year":"2023","journal-title":"Stress Health J. Int. Soc. Investig. 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