Friday, December 10, 2004

Iraq death rate lower, but wounds are worse (12/10/04)

Iraq death rate lower, but wounds are worse
By Raja Mishra The Boston Globe

Amputation percentage alarms doctors

BOSTON U.S. troops wounded in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck wounds that may require a lifetime of care, according to new data that gives the clearest picture yet of the severity of battlefield wounds.
.
The data are the grisly flip side of the improvement in battlefield medicine that has saved combatants who would have died in the past. Only one in 10 U.S. troops wounded in Iraq has died, the lowest rate of any war in U.S. history.
.
But those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks.
.
More than half of those wounded sustain wounds so serious they cannot return to duty, according to Pentagon statistics.
.
Much attention has focused on the 1,000-plus soldiers killed in Iraq, but the Pentagon had released little information on the 9,765 soldiers wounded as of this week.
.
"The death rate isn't great compared to Vietnam, Korea and World War II," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired U.S. Army surgeon who served as a civilian adviser in Iraq earlier this year. "But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying."
.
Responding to the large number of amputations, scientists at Brown University in Providence, Rhode Island, and at the Massachusetts Institute of Technology on Wednesday announced a $7.2 million research program over five years to design more functional prosthetic limbs. The U.S. Department of Veterans Affairs is paying for the work.
.
Data compiled by the U.S. Senate, and included in the 2005 defense appropriations bill in support of a request for increased funding for the care of amputees at Walter Reed Army Medical Center, revealed that 6 percent of those wounded in Iraq have required amputations, compared with a rate of 3 percent for past wars.
.
Dr. Roy Aaron, of the Brown Medical School, said the current Veterans Affairs medical system "literally cannot handle the load" of amputees.
.
"Amputee research has never been a high priority" because it's not "fashionable," said Aaron, who is heading the Brown-MIT effort. "Iraq has changed that."
.
Stephan Fihn, the acting chief of research and development for the Veterans Affairs Department, said that military officials were concerned about the expected flood of amputees but that the system would "absolutely, without a doubt" be able to handle them.
.
"Returning veterans from Iraq and Afghanistan are our highest priority now," he said.
.
The Brown-MIT project will explore methods to build better titanium prosthetic limbs, extend bone stumps for tighter attachment of prosthetics and use computer technology to develop prosthetic devices that can be controlled by brain sensors implanted in patients. However, the advances will not be ready for years, and many Iraq veterans will not immediately benefit, Aaron said.
.
In Thursday's New England Journal of Medicine, Dr. Atul Gawande, a journalist and Harvard surgeon, writes: "The nation's military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties."
.
In World War II, about 30 percent of those wounded died, and in Vietnam the figure was 24 percent. In Afghanistan, as in Iraq, the mortality rate has been 10 percent.
.
Gawande and others credited improvements made after Vietnam, when medics noted that most soldiers who made it to surgical facilities survived. In Iraq, military field surgical teams work just behind front lines, with four surgeons and a nursing team able to erect a four-bed surgical unit in one hour. In the current conflict, the average time it takes a wounded soldier to go from the battlefield to front-line care and on to full-service military hospitals in Germany, Kuwait and Spain has been about four days, compared with weeks in previous wars.
.
In addition to amputations, many soldiers making this journey have head and neck wounds, frequently wounded by improvised explosive devices essentially remote-controlled bombs planted in the ground.
.
Lieutenant Colonel Michael Xydakis, a military surgeon, released a little-noticed study in September at a medical conference of head and neck surgeons. He found that over a 14-month period, about one in five U.S. soldiers treated at Landstuhl Regional Medical Center in Germany, which handles most Iraq casualties, had head or neck wounds.
.
These wounds, surgeons said, have long-term implications, with many involving irreversible brain damage, breathing and eating impairments, blindness, or severe disfiguration. The study prompted the military to add a full-time head and neck surgeon to a Baghdad field hospital.
.
"These folks are just starting to come back, and they may require care for a long, long time," Holt said.
.Amputation percentage alarms doctors

BOSTON U.S. troops wounded in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck wounds that may require a lifetime of care, according to new data that gives the clearest picture yet of the severity of battlefield wounds.
.
The data are the grisly flip side of the improvement in battlefield medicine that has saved combatants who would have died in the past. Only one in 10 U.S. troops wounded in Iraq has died, the lowest rate of any war in U.S. history.
.
But those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks.
.
More than half of those wounded sustain wounds so serious they cannot return to duty, according to Pentagon statistics.
.
Much attention has focused on the 1,000-plus soldiers killed in Iraq, but the Pentagon had released little information on the 9,765 soldiers wounded as of this week.
.
"The death rate isn't great compared to Vietnam, Korea and World War II," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired U.S. Army surgeon who served as a civilian adviser in Iraq earlier this year. "But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying."
.
Responding to the large number of amputations, scientists at Brown University in Providence, Rhode Island, and at the Massachusetts Institute of Technology on Wednesday announced a $7.2 million research program over five years to design more functional prosthetic limbs. The U.S. Department of Veterans Affairs is paying for the work.
.
Data compiled by the U.S. Senate, and included in the 2005 defense appropriations bill in support of a request for increased funding for the care of amputees at Walter Reed Army Medical Center, revealed that 6 percent of those wounded in Iraq have required amputations, compared with a rate of 3 percent for past wars.
.
Dr. Roy Aaron, of the Brown Medical School, said the current Veterans Affairs medical system "literally cannot handle the load" of amputees.
.
"Amputee research has never been a high priority" because it's not "fashionable," said Aaron, who is heading the Brown-MIT effort. "Iraq has changed that."
.
Stephan Fihn, the acting chief of research and development for the Veterans Affairs Department, said that military officials were concerned about the expected flood of amputees but that the system would "absolutely, without a doubt" be able to handle them.
.
"Returning veterans from Iraq and Afghanistan are our highest priority now," he said.
.
The Brown-MIT project will explore methods to build better titanium prosthetic limbs, extend bone stumps for tighter attachment of prosthetics and use computer technology to develop prosthetic devices that can be controlled by brain sensors implanted in patients. However, the advances will not be ready for years, and many Iraq veterans will not immediately benefit, Aaron said.
.
In Thursday's New England Journal of Medicine, Dr. Atul Gawande, a journalist and Harvard surgeon, writes: "The nation's military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties."
.
In World War II, about 30 percent of those wounded died, and in Vietnam the figure was 24 percent. In Afghanistan, as in Iraq, the mortality rate has been 10 percent.
.
Gawande and others credited improvements made after Vietnam, when medics noted that most soldiers who made it to surgical facilities survived. In Iraq, military field surgical teams work just behind front lines, with four surgeons and a nursing team able to erect a four-bed surgical unit in one hour. In the current conflict, the average time it takes a wounded soldier to go from the battlefield to front-line care and on to full-service military hospitals in Germany, Kuwait and Spain has been about four days, compared with weeks in previous wars.
.
In addition to amputations, many soldiers making this journey have head and neck wounds, frequently wounded by improvised explosive devices essentially remote-controlled bombs planted in the ground.
.
Lieutenant Colonel Michael Xydakis, a military surgeon, released a little-noticed study in September at a medical conference of head and neck surgeons. He found that over a 14-month period, about one in five U.S. soldiers treated at Landstuhl Regional Medical Center in Germany, which handles most Iraq casualties, had head or neck wounds.
.
These wounds, surgeons said, have long-term implications, with many involving irreversible brain damage, breathing and eating impairments, blindness, or severe disfiguration. The study prompted the military to add a full-time head and neck surgeon to a Baghdad field hospital.
.
"These folks are just starting to come back, and they may require care for a long, long time," Holt said.
.Amputation percentage alarms doctors

BOSTON U.S. troops wounded in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck wounds that may require a lifetime of care, according to new data that gives the clearest picture yet of the severity of battlefield wounds.
.
The data are the grisly flip side of the improvement in battlefield medicine that has saved combatants who would have died in the past. Only one in 10 U.S. troops wounded in Iraq has died, the lowest rate of any war in U.S. history.
.
But those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks.
.
More than half of those wounded sustain wounds so serious they cannot return to duty, according to Pentagon statistics.
.
Much attention has focused on the 1,000-plus soldiers killed in Iraq, but the Pentagon had released little information on the 9,765 soldiers wounded as of this week.
.
"The death rate isn't great compared to Vietnam, Korea and World War II," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired U.S. Army surgeon who served as a civilian adviser in Iraq earlier this year. "But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying."
.
Responding to the large number of amputations, scientists at Brown University in Providence, Rhode Island, and at the Massachusetts Institute of



See more of the world that matters - click here for home delivery of the International Herald Tribune.
< < Back to Start of Article Amputation percentage alarms doctors

BOSTON U.S. troops wounded in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck wounds that may require a lifetime of care, according to new data that gives the clearest picture yet of the severity of battlefield wounds.
.
The data are the grisly flip side of the improvement in battlefield medicine that has saved combatants who would have died in the past. Only one in 10 U.S. troops wounded in Iraq has died, the lowest rate of any war in U.S. history.
.
But those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks.
.
More than half of those wounded sustain wounds so serious they cannot return to duty, according to Pentagon statistics.
.
Much attention has focused on the 1,000-plus soldiers killed in Iraq, but the Pentagon had released little information on the 9,765 soldiers wounded as of this week.
.
"The death rate isn't great compared to Vietnam, Korea and World War II," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired U.S. Army surgeon who served as a civilian adviser in Iraq earlier this year. "But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying."
.
Responding to the large number of amputations, scientists at Brown University in Providence, Rhode Island, and at the Massachusetts Institute of Technology on Wednesday announced a $7.2 million research program over five years to design more functional prosthetic limbs. The U.S. Department of Veterans Affairs is paying for the work.
.
Data compiled by the U.S. Senate, and included in the 2005 defense appropriations bill in support of a request for increased funding for the care of amputees at Walter Reed Army Medical Center, revealed that 6 percent of those wounded in Iraq have required amputations, compared with a rate of 3 percent for past wars.
.
Dr. Roy Aaron, of the Brown Medical School, said the current Veterans Affairs medical system "literally cannot handle the load" of amputees.
.
"Amputee research has never been a high priority" because it's not "fashionable," said Aaron, who is heading the Brown-MIT effort. "Iraq has changed that."
.
Stephan Fihn, the acting chief of research and development for the Veterans Affairs Department, said that military officials were concerned about the expected flood of amputees but that the system would "absolutely, without a doubt" be able to handle them.
.
"Returning veterans from Iraq and Afghanistan are our highest priority now," he said.
.
The Brown-MIT project will explore methods to build better titanium prosthetic limbs, extend bone stumps for tighter attachment of prosthetics and use computer technology to develop prosthetic devices that can be controlled by brain sensors implanted in patients. However, the advances will not be ready for years, and many Iraq veterans will not immediately benefit, Aaron said.
.
In Thursday's New England Journal of Medicine, Dr. Atul Gawande, a journalist and Harvard surgeon, writes: "The nation's military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties."
.
In World War II, about 30 percent of those wounded died, and in Vietnam the figure was 24 percent. In Afghanistan, as in Iraq, the mortality rate has been 10 percent.
.
Gawande and others credited improvements made after Vietnam, when medics noted that most soldiers who made it to surgical facilities survived. In Iraq, military field surgical teams work just behind front lines, with four surgeons and a nursing team able to erect a four-bed surgical unit in one hour. In the current conflict, the average time it takes a wounded soldier to go from the battlefield to front-line care and on to full-service military hospitals in Germany, Kuwait and Spain has been about four days, compared with weeks in previous wars.
.
In addition to amputations, many soldiers making this journey have head and neck wounds, frequently wounded by improvised explosive devices essentially remote-controlled bombs planted in the ground.
.
Lieutenant Colonel Michael Xydakis, a military surgeon, released a little-noticed study in September at a medical conference of head and neck surgeons. He found that over a 14-month period, about one in five U.S. soldiers treated at Landstuhl Regional Medical Center in Germany, which handles most Iraq casualties, had head or neck wounds.
.
These wounds, surgeons said, have long-term implications, with many involving irreversible brain damage, breathing and eating impairments, blindness, or severe disfiguration. The study prompted the military to add a full-time head and neck surgeon to a Baghdad field hospital.
.
"These folks are just starting to come back, and they may require care for a long, long time," Holt said.
.Amputation percentage alarms doctors

BOSTON U.S. troops wounded in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck wounds that may require a lifetime of care, according to new data that gives the clearest picture yet of the severity of battlefield wounds.
.
The data are the grisly flip side of the improvement in battlefield medicine that has saved combatants who would have died in the past. Only one in 10 U.S. troops wounded in Iraq has died, the lowest rate of any war in U.S. history.
.
But those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks.
.
More than half of those wounded sustain wounds so serious they cannot return to duty, according to Pentagon statistics.
.
Much attention has focused on the 1,000-plus soldiers killed in Iraq, but the Pentagon had released little information on the 9,765 soldiers wounded as of this week.
.
"The death rate isn't great compared to Vietnam, Korea and World War II," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired U.S. Army surgeon who served as a civilian adviser in Iraq earlier this year. "But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying."
.
Responding to the large number of amputations, scientists at Brown University in Providence, Rhode Island, and at the Massachusetts Institute of Technology on Wednesday announced a $7.2 million research program over five years to design more functional prosthetic limbs. The U.S. Department of Veterans Affairs is paying for the work.
.
Data compiled by the U.S. Senate, and included in the 2005 defense appropriations bill in support of a request for increased funding for the care of amputees at Walter Reed Army Medical Center, revealed that 6 percent of those wounded in Iraq have required amputations, compared with a rate of 3 percent for past wars.
.
Dr. Roy Aaron, of the Brown Medical School, said the current Veterans Affairs medical system "literally cannot handle the load" of amputees.
.
"Amputee research has never been a high priority" because it's not "fashionable," said Aaron, who is heading the Brown-MIT effort. "Iraq has changed that."
.
Stephan Fihn, the acting chief of research and development for the Veterans Affairs Department, said that military officials were concerned about the expected flood of amputees but that the system would "absolutely, without a doubt" be able to handle them.
.
"Returning veterans from Iraq and Afghanistan are our highest priority now," he said.
.
The Brown-MIT project will explore methods to build better titanium prosthetic limbs, extend bone stumps for tighter attachment of prosthetics and use computer technology to develop prosthetic devices that can be controlled by brain sensors implanted in patients. However, the advances will not be ready for years, and many Iraq veterans will not immediately benefit, Aaron said.
.
In Thursday's New England Journal of Medicine, Dr. Atul Gawande, a journalist and Harvard surgeon, writes: "The nation's military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties."
.
In World War II, about 30 percent of those wounded died, and in Vietnam the figure was 24 percent. In Afghanistan, as in Iraq, the mortality rate has been 10 percent.
.
Gawande and others credited improvements made after Vietnam, when medics noted that most soldiers who made it to surgical facilities survived. In Iraq, military field surgical teams work just behind front lines, with four surgeons and a nursing team able to erect a four-bed surgical unit in one hour. In the current conflict, the average time it takes a wounded soldier to go from the battlefield to front-line care and on to full-service military hospitals in Germany, Kuwait and Spain has been about four days, compared with weeks in previous wars.
.
In addition to amputations, many soldiers making this journey have head and neck wounds, frequently wounded by improvised explosive devices essentially remote-controlled bombs planted in the ground.
.
Lieutenant Colonel Michael Xydakis, a military surgeon, released a little-noticed study in September at a medical conference of head and neck surgeons. He found that over a 14-month period, about one in five U.S. soldiers treated at Landstuhl Regional Medical Center in Germany, which handles most Iraq casualties, had head or neck wounds.
.
These wounds, surgeons said, have long-term implications, with many involving irreversible brain damage, breathing and eating impairments, blindness, or severe disfiguration. The study prompted the military to add a full-time head and neck surgeon to a Baghdad field hospital.
.
"These folks are just starting to come back, and they may require care for a long, long time," Holt said.
.Amputation percentage alarms doctors

BOSTON U.S. troops wounded in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck wounds that may require a lifetime of care, according to new data that gives the clearest picture yet of the severity of battlefield wounds.
.
The data are the grisly flip side of the improvement in battlefield medicine that has saved combatants who would have died in the past. Only one in 10 U.S. troops wounded in Iraq has died, the lowest rate of any war in U.S. history.
.
But those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks.
.
More than half of those wounded sustain wounds so serious they cannot return to duty, according to Pentagon statistics.
.
Much attention has focused on the 1,000-plus soldiers killed in Iraq, but the Pentagon had released little information on the 9,765 soldiers wounded as of this week.
.
"The death rate isn't great compared to Vietnam, Korea and World War II," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired U.S. Army surgeon who served as a civilian adviser in Iraq earlier this year. "But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying."
.
Responding to the large number of amputations, scientists at Brown University in Providence, Rhode Island, and at the Massachusetts Institute of Technology on Wednesday announced a $7.2 million research program over five years to design more functional prosthetic limbs. The U.S. Department of Veterans Affairs is paying for the work.
.
Data compiled by the U.S. Senate, and included in the 2005 defense appropriations bill in support of a request for increased funding for the care of amputees at Walter Reed Army Medical Center, revealed that 6 percent of those wounded in Iraq have required amputations, compared with a rate of 3 percent for past wars.
.
Dr. Roy Aaron, of the Brown Medical School, said the current Veterans Affairs medical system "literally cannot handle the load" of amputees.
.
"Amputee research has never been a high priority" because it's not "fashionable," said Aaron, who is heading the Brown-MIT effort. "Iraq has changed that."
.
Stephan Fihn, the acting chief of research and development for the Veterans Affairs Department, said that military officials were concerned about the expected flood of amputees but that the system would "absolutely, without a doubt" be able to handle them.
.
"Returning veterans from Iraq and Afghanistan are our highest priority now," he said.
.
The Brown-MIT project will explore methods to build better titanium prosthetic limbs, extend bone stumps for tighter attachment of prosthetics and use computer technology to develop prosthetic devices that can be controlled by brain sensors implanted in patients. However, the advances will not be ready for years, and many Iraq veterans will not immediately benefit, Aaron said.
.
In Thursday's New England Journal of Medicine, Dr. Atul Gawande, a journalist



See more of the world that matters - click here for home delivery of the International Herald Tribune.
< < Back to Start of Article Amputation percentage alarms doctors

BOSTON U.S. troops wounded in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck wounds that may require a lifetime of care, according to new data that gives the clearest picture yet of the severity of battlefield wounds.
.
The data are the grisly flip side of the improvement in battlefield medicine that has saved combatants who would have died in the past. Only one in 10 U.S. troops wounded in Iraq has died, the lowest rate of any war in U.S. history.
.
But those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks.
.
More than half of those wounded sustain wounds so serious they cannot return to duty, according to Pentagon statistics.
.
Much attention has focused on the 1,000-plus soldiers killed in Iraq, but the Pentagon had released little information on the 9,765 soldiers wounded as of this week.
.
"The death rate isn't great compared to Vietnam, Korea and World War II," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired U.S. Army surgeon who served as a civilian adviser in Iraq earlier this year. "But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying."
.
Responding to the large number of amputations, scientists at Brown University in Providence, Rhode Island, and at the Massachusetts Institute of Technology on Wednesday announced a $7.2 million research program over five years to design more functional prosthetic limbs. The U.S. Department of Veterans Affairs is paying for the work.
.
Data compiled by the U.S. Senate, and included in the 2005 defense appropriations bill in support of a request for increased funding for the care of amputees at Walter Reed Army Medical Center, revealed that 6 percent of those wounded in Iraq have required amputations, compared with a rate of 3 percent for past wars.
.
Dr. Roy Aaron, of the Brown Medical School, said the current Veterans Affairs medical system "literally cannot handle the load" of amputees.
.
"Amputee research has never been a high priority" because it's not "fashionable," said Aaron, who is heading the Brown-MIT effort. "Iraq has changed that."
.
Stephan Fihn, the acting chief of research and development for the Veterans Affairs Department, said that military officials were concerned about the expected flood of amputees but that the system would "absolutely, without a doubt" be able to handle them.
.
"Returning veterans from Iraq and Afghanistan are our highest priority now," he said.
.
The Brown-MIT project will explore methods to build better titanium prosthetic limbs, extend bone stumps for tighter attachment of prosthetics and use computer technology to develop prosthetic devices that can be controlled by brain sensors implanted in patients. However, the advances will not be ready for years, and many Iraq veterans will not immediately benefit, Aaron said.
.
In Thursday's New England Journal of Medicine, Dr. Atul Gawande, a journalist and Harvard surgeon, writes: "The nation's military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties."
.
In World War II, about 30 percent of those wounded died, and in Vietnam the figure was 24 percent. In Afghanistan, as in Iraq, the mortality rate has been 10 percent.
.
Gawande and others credited improvements made after Vietnam, when medics noted that most soldiers who made it to surgical facilities survived. In Iraq, military field surgical teams work just behind front lines, with four surgeons and a nursing team able to erect a four-bed surgical unit in one hour. In the current conflict, the average time it takes a wounded soldier to go from the battlefield to front-line care and on to full-service military hospitals in Germany, Kuwait and Spain has been about four days, compared with weeks in previous wars.
.
In addition to amputations, many soldiers making this journey have head and neck wounds, frequently wounded by improvised explosive devices essentially remote-controlled bombs planted in the ground.
.
Lieutenant Colonel Michael Xydakis, a military surgeon, released a little-noticed study in September at a medical conference of head and neck surgeons. He found that over a 14-month period, about one in five U.S. soldiers treated at Landstuhl Regional Medical Center in Germany, which handles most Iraq casualties, had head or neck wounds.
.
These wounds, surgeons said, have long-term implications, with many involving irreversible brain damage, breathing and eating impairments, blindness, or severe disfiguration. The study prompted the military to add a full-time head and neck surgeon to a Baghdad field hospital.
.
"These folks are just starting to come back, and they may require care for a long, long time," Holt said.
.Amputation percentage alarms doctors

BOSTON U.S. troops wounded in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck wounds that may require a lifetime of care, according to new data that gives the clearest picture yet of the severity of battlefield wounds.
.
The data are the grisly flip side of the improvement in battlefield medicine that has saved combatants who would have died in the past. Only one in 10 U.S. troops wounded in Iraq has died, the lowest rate of any war in U.S. history.
.
But those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks.
.
More than half of those wounded sustain wounds so serious they cannot return to duty, according to Pentagon statistics.
.
Much attention has focused on the 1,000-plus soldiers killed in Iraq, but the Pentagon had released little information on the 9,765 soldiers wounded as of this week.
.
"The death rate isn't great compared to Vietnam, Korea and World War II," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired U.S. Army surgeon who served as a civilian adviser in Iraq earlier this year. "But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying."
.
Responding to the large number of amputations, scientists at Brown University in Providence, Rhode Island, and at the Massachusetts Institute of Technology on Wednesday announced a $7.2 million research program over five years to design more functional prosthetic limbs. The U.S. Department of Veterans Affairs is paying for the work.
.
Data compiled by the U.S. Senate, and included in the 2005 defense appropriations bill in support of a request for increased funding for the care of amputees at Walter Reed Army Medical Center, revealed that 6 percent of those wounded in Iraq have required amputations, compared with a rate of 3 percent for past wars.
.
Dr. Roy Aaron, of the Brown Medical School, said the current Veterans Affairs medical system "literally cannot handle the load" of amputees.
.
"Amputee research has never been a high priority" because it's not "fashionable," said Aaron, who is heading the Brown-MIT effort. "Iraq has changed that."
.
Stephan Fihn, the acting chief of research and development for the Veterans Affairs Department, said that military officials were concerned about the expected flood of amputees but that the system would "absolutely, without a doubt" be able to handle them.
.
"Returning veterans from Iraq and Afghanistan are our highest priority now," he said.
.
The Brown-MIT project will explore methods to build better titanium prosthetic limbs, extend bone stumps for tighter attachment of prosthetics and use computer technology to develop prosthetic devices that can be controlled by brain sensors implanted in patients. However, the advances will not be ready for years, and many Iraq veterans will not immediately benefit, Aaron said.
.
In Thursday's New England Journal of Medicine, Dr. Atul Gawande, a journalist and Harvard surgeon, writes: "The nation's military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties."
.
In World War II, about 30 percent of those wounded died, and in Vietnam the figure was 24 percent. In Afghanistan, as in Iraq, the mortality rate has been 10 percent.
.
Gawande and others credited improvements made after Vietnam, when medics noted that most soldiers who made it to surgical facilities survived. In Iraq, military field surgical teams work just behind front lines, with four surgeons and a nursing team able to erect a four-bed surgical unit in one hour. In the current conflict, the average time it takes a wounded soldier to go from the battlefield to front-line care and on to full-service military hospitals in Germany, Kuwait and Spain has been about four days, compared with weeks in previous wars.
.
In addition to amputations, many soldiers making this journey have head and neck wounds, frequently wounded by improvised explosive devices essentially remote-controlled bombs planted in the ground.
.
Lieutenant Colonel Michael Xydakis, a military surgeon, released a little-noticed study in September at a medical conference of head and neck surgeons. He found that over a 14-month period, about one in five U.S. soldiers treated at Landstuhl Regional Medical Center in Germany, which handles most Iraq casualties, had head or neck wounds.
.
These wounds, surgeons said, have long-term implications, with many involving irreversible brain damage, breathing and eating impairments, blindness, or severe disfiguration. The study prompted the military to add a full-time head and neck surgeon to a Baghdad field hospital.
.
"These folks are just starting to come back, and they may require care for a long, long time," Holt said.
.Amputation percentage alarms doctors

BOSTON U.S. troops wounded in Iraq have required limb amputations at twice the rate of past wars, and as many as 20 percent have suffered head and neck wounds that may require a lifetime of care, according to new data that gives the clearest picture yet of the severity of battlefield wounds.
.
The data are the grisly flip side of the improvement in battlefield medicine that has saved combatants who would have died in the past. Only one in 10 U.S. troops wounded in Iraq has died, the lowest rate of any war in U.S. history.
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But those who survive have much more grievous wounds. Bulletproof Kevlar vests protect soldiers' bodies but not their limbs, as insurgent snipers and makeshift bombs tear off arms and legs and rip into faces and necks.
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More than half of those wounded sustain wounds so serious they cannot return to duty, according to Pentagon statistics.
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Much attention has focused on the 1,000-plus soldiers killed in Iraq, but the Pentagon had released little information on the 9,765 soldiers wounded as of this week.
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"The death rate isn't great compared to Vietnam, Korea and World War II," said Dr. G. Richard Holt, a head and neck surgeon at the University of Texas Health Science Center in San Antonio and a retired U.S. Army surgeon who served as a civilian adviser in Iraq earlier this year. "But these soldiers are coming back to their communities and people are seeing just how high the price is that these young people are paying."
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Responding to the large number of amputations, scientists at Brown University in Providence, Rhode Island, and at the Massachusetts Institute of Technology on Wednesday announced a $7.2 million research program over five years to design more functional prosthetic limbs. The U.S. Department of Veterans Affairs is paying for the work.
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Data compiled by the U.S. Senate, and included in the 2005 defense appropriations bill in support of a request for increased funding for the care of amputees at Walter Reed Army Medical Center, revealed that 6 percent of those wounded in Iraq have required amputations, compared with a rate of 3 percent for past wars.
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Dr. Roy Aaron, of the Brown Medical School, said the current Veterans Affairs medical system "literally cannot handle the load" of amputees.
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"Amputee research has never been a high priority" because it's not "fashionable," said Aaron, who is heading the Brown-MIT effort. "Iraq has changed that."
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Stephan Fihn, the acting chief of research and development for the Veterans Affairs Department, said that military officials were concerned about the expected flood of amputees but that the system would "absolutely, without a doubt" be able to handle them.
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"Returning veterans from Iraq and Afghanistan are our highest priority now," he said.
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The Brown-MIT project will explore methods to build better titanium prosthetic limbs, extend bone stumps for tighter attachment of prosthetics and use computer technology to develop prosthetic devices that can be controlled by brain sensors implanted in patients. However, the advances will not be ready for years, and many Iraq veterans will not immediately benefit, Aaron said.
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In Thursday's New England Journal of Medicine, Dr. Atul Gawande, a journalist and Harvard surgeon, writes: "The nation's military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties."
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In World War II, about 30 percent of those wounded died, and in Vietnam the figure was 24 percent. In Afghanistan, as in Iraq, the mortality rate has been 10 percent.
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Gawande and others credited improvements made after Vietnam, when medics noted that most soldiers who made it to surgical facilities survived. In Iraq, military field surgical teams work just behind front lines, with four surgeons and a nursing team able to erect a four-bed surgical unit in one hour. In the current conflict, the average time it takes a wounded soldier to go from the battlefield to front-line care and on to full-service military hospitals in Germany, Kuwait and Spain has been about four days, compared with weeks in previous wars.
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In addition to amputations, many soldiers making this journey have head and neck wounds, frequently wounded by improvised explosive devices essentially remote-controlled bombs planted in the ground.
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Lieutenant Colonel Michael Xydakis, a military surgeon, released a little-noticed study in September at a medical conference of head and neck surgeons. He found that over a 14-month period, about one in five U.S. soldiers treated at Landstuhl Regional Medical Center in Germany, which handles most Iraq casualties, had head or neck wounds.
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These wounds, surgeons said, have long-term implications, with many involving irreversible brain damage, breathing and eating impairments, blindness, or severe disfiguration. The study prompted the military to add a full-time head and neck surgeon to a

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