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Orthopedics Restores Limbs, Lives

By Donna Miles
American Forces Press Service

FORT SAM HOUSTON, Texas, Sept. 16, 2004 – Orthopedic surgeons here at Brooke Army Medical Center are doing more than restoring limbs for troops wounded in combat. Armed with the latest surgical techniques and state-of-the-art technology, they're giving wounded troops the tools to rebuild their lives.

Army Col. Mark Bagg, chief of orthopedics here and orthopedic consultant to the Army Surgeon General, said body armor and Kevlar helmets are "really saving lives" on the battlefield. Yet, while these protections safeguard the torso and head, they leave other parts of the body exposed to bombs, rocket-propelled grenades and other explosives. The result: about 65 percent of combat injuries involve the extremities.

During past wars, amputation was often the only treatment possible for severely damaged arms and legs. But before modern surgical techniques, amputation was a crude, excruciating operation in which most patients died either on the operating table or later, from infection and gangrene.

But today, Bagg credits new procedures with saving limbs that might have once been deemed unsalvageable. And in cases where amputation is necessary, Bagg said, technological advances have made prostheses so good that their wearers can go on to live relatively normal lives.

Reconstruction -- although making tremendous strides -- can require multiple surgeries and recoveries. "Some of these reconstructions take a lot of time and a lot of rehabilitation and involve a lot of pain," said Army Lt. Col. Roman Hayda, chief of orthopedic trauma at the hospital.

Yet, Hayda said, many patients are willing to fight to save their limbs. "What strikes me with these patients is that they are all very motivated and very willing," he said. "They know they have a bad injury but want to make the most of what they have."

Hayda and Bagg agree that in some cases, amputation is the better option. It's a decision they say can't and shouldn't be taken lightly, and one with tremendous emotional consequences. "No surgeon takes the process of doing an amputation lightly," said Hayda. "Usually it's a decision made by the injury itself."

With huge improvements in prostheses, Bagg said, amputation is often the better alternative for the wounded service member. Vacuum-assisted socket systems for below-knee prostheses prevent blistering, scarring and swelling. Above-knee prostheses with microprocessors adjust 50 times a second to the speed of a person walking to ensure stability. Prosthetic forearms are being fitted with myoelectric robotic hands that provide almost lifelike movement. Rubberized hands are engineered to detect pressure, and sensors designed into the fingers detect the resistance an object exerts.

"Sometimes a prosthesis can work better than a leg," Bagg said.

Consider the case of Army Spc. B.J. Jackson, an Iowa National Guard soldier whose Humvee tripped a phosphorous landmine hidden along the road in downtown Baghdad last August. The explosion, compounded by four hits from rocket- propelled grenade fire on his vehicle door, left Jackson's legs mangled and seriously burned. Unable to save the limbs, U.S. Army doctors in Iraqi amputated both Jackson's legs.

Like all orthopedic patients, Jackson went through the long process of recovery, with physical and occupational therapy and numerous medical follow- ups. Yet four months later, he was not only walking, but also running and snow skiing.

Now medically retired from the Army, he returned to Brooke Army Medical Center last week to receive his sixth set of prosthetic legs. "The technology is getting better every day," he said.

This set, one laminated with images of the 9/11 postage and the other, with logos of his beloved NFL Kansas City Chiefs, is held in place with a vacuum- assisted socket system and restores Jackson to his original 6-foot-6-inch height.

Carefree and optimistic by nature, Jackson credits the staff at Brooke Army Medical Center, as well as his wife and children who stood by him throughout his ordeal, with helping him get back on his feet -- literally.

The biggest annoyance, he said, was when the bouncer at a nightclub denied him and his wife admission because Jackson was wearing running shoes, in violation of the club's dress code. Jackson hadn't yet learned how to change the shoes attached to his prostheses. He showed the bouncer his artificial legs and explained his predicament, but was still denied entrance. "That really got my wife mad," he said.

Jackson has come a long way since that day. He's learned to change his shoes, most recently sporting a pair of open-toed sandals. He's become deeply involved in the Coalition to Salute America's Heroes, a nonprofit organization committed to helping wounded troops. And he's looking to the future, with plans to return to college after his wife finishes her nursing degree.

The day he received his newest set of legs, Jackson boarded a plane at San Antonio International Airport, headed home to his family in Des Moines, Iowa. Curious eyes paused on Jackson's colorful new legs, revealed under a pair of khaki shorts.

"It's hot out, so why would I wear long pants?" he said, after being questioned about his decision not to cover his legs. "Besides, I'm not ashamed. This is just something that happened to me. Life goes on."

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