Limb Salvage, Reconstruction, Restoration Care are at the Core of Provider Training

Limb Salvage, Reconstruction, Restoration Care are at the Core of Provider Training

The Limb Trauma Educational Series offers providers involved in limb trauma and amputation care clinically relevant education that can be used in their practice. The series is sponsored by the Extremity Trauma and Amputation Center of Excellence, part of the Research and Engineering Directorate under the Defense Health Agency.

The LTES occurs monthly on the fourth Wednesday, from 12-1 p.m. ET, on ZoomGov.com. This educational event is open to everyone, so interested clinicians should feel free to share the information widely.

U.S. Air Force Col. (Dr.) Brandon Propper, a vascular surgeon at the Uniformed Services University, will lead the April 24 meeting, focusing on vascular techniques through the treatment and open surgical management of vascular injuries. Arterial injury and reconstruction and venous injury will be covered in the context of limb salvage.

The training "allows attendees to hear about military relevant topics that are applicable to combat surgery," Propper said. "Many of the topics show extreme examples, but the talks provide tips and tricks for unusual scenarios that medical personnel may encounter."

Additional EACE Training

"Every other year, the EACE sponsors the Federal Advanced Skills Training that historically focused on amputation care," Lutz said. "In 2023, we pivoted to examining the leading surgical concepts in limb salvage, limb reconstruction, and limb restoration." That includes osseointegration surgery, which is a technique in which a metal implant is integrated into the patient's bone and extends externally through an opening in the skin to allow a prosthesis (artificial limb) to be attached directly.

Planning for the next skills training is underway, with a tentative date of summer 2025.

Historically, each FAST includes podium presentations in the morning with afternoon hands-on skills training, aimed at reinforcing the knowledge gained in the morning sessions. When possible, the FAST training includes cadaver labs to maximize the benefit of this immersive experience.

EACE Roles

EACE staff participate in developing Military Health System standards, clinical practice guidelines, and Department of Defense policy. EACE researchers' work "is relevant to its training and education program as it provides both the evidence base and the content for our programs," Lutz said.

Since 2014, all EACE education and training are archived for education purposes and hosted on the Joint Knowledge Online Virtual Classroom, also called JKO VCLASS.

EACE clinicians, MHS clinicians, and Department of Veterans Affairs clinicians work with the VA/DOD Evidence-Based Practice Guideline Work Group, which has issued two amputation focused clinical practice guidelines. These guidelines provide the framework for evidence-based best practices:

• Rehabilitation of Lower Limb Amputation, Version 2 - 2017
• Management of Upper Limb Amputation Rehabilitation (ULA) - 2022

The work group also looks at clinical gaps. In 2022, for example, the group published a novel patient handout on pregnancy in those with upper limb amputation and added content on parenting and child care to the patient handbook "Within Reach."

Since 2001, the DOD has cared for more than 63,000 beneficiaries with some level of limb loss, including almost 1,750 service members with deployment-related amputations. Of that number, more than 400 service members have returned to duty thanks to advancements in military research and a holistic approach to patient care.