published Saturday, April 20th, 2013

Medical advances to aid boston survivors

While police were pursuing the surviving suspect Friday in the bombings at the Boston Marathon, the story emerged of Jeffrey Bauman. Within minutes of awakening from surgery that took both his legs beneath the knee, Bauman scribbled a note to his brother asking to see the police. He had looked into the eyes of the man who dropped the backpack that exploded near him a few minutes later, and he could identify the bomber.

Assistance from Bauman and other spectators was precisely what the FBI was seeking. After intensive scanning of footage collected by the city's security cameras near the explosions, authorities were quickly able to post pictures of suspects. Just as Boston's well-placed network of security cameras -- a post 9/ll project -- enhanced pursuit of the bombing suspects, Bauman and other victims who lost limbs in the bombing may benefit from medical advances that also have been pushed to the forefront since the terrorist attacks of Sept. 11, 2001.

The Boston bombs mimicked the improvised explosive devices, or IEDs, that became the scourge of asymmetrical warfare in Afghanistan and Iraq. While the U.S. military was forced to play catch-up with better armored vehicles and troop carriers, IEDs are still costing American lives in Afghanistan. Fortunately, medical practices for trauma care, rehabilitative surgery and prostheses, especially those for artificial limbs, have also experienced leapfrog advances in the past decade due to the exigencies of combat.

American physicians who practice trauma care and vascular, orthopedic and plastic surgery have had access to continuing education in the military's forced advances. And patients, if they can afford it, can also benefit from new high-tech protheses, like those for lower legs that make swimming, running, biking, skiing and even rock-climbing possible.

Participating trauma physicians have been learning better triage techniques that take a multi-step approach to surgery for blast and accident victims. They often employ temporary repairs rather than trying to repair bones, blood vessels and tissue grafts all at once, according to a New York Times report on advanced medical care methods being utilized in the wake of the Boston bombings.

They may, for example, leave small pieces of shrapnel rather than digging it all out. They may use temporary exterior plates to stabilize bones with multiple fractures while soft tissue repairs take priority. They tend to use smaller pieces of transplanted muscle and tissue to repair gaps left by wounds, rather than large chunks taken from the back and abdomen. They may adopt a series of surgeries as a patient's progress continues. And when they get to permanent repairs for multiple fractures, they may employ contour plates with screws, rather than flat plates and pins, to prevent bone movement and produce faster healing.

While these advancing surgical and trauma-care techniques are important, they appear to pale against the military's rapidly advancing technology in protheses over the past 11 years of war, which has taken limbs from more than 1,600 American military members.

A New York Times report compared today's high-tech protheses to the false legs made of balsa and plastic laminate in the Vietnam War era. Today, the advanced replacement limbs are made of strong, lightweight titanium and carbon fiber. They utilize microprocessors that provide computerized knees and ankles which allow a wide scope of useful functions.

With the use of such technology, The Times James Dao reported, a Navy explosives expert, John Kremer, who lost both his legs beneath his knees, was able to walk within two months, sky-dive after nine months, and participate in a six-mile run after a year. He now swims, bikes and runs almost daily. Similarly, a disabled Vietnam veteran, Kirk Bauer, who lost his left leg above the knee in 1969, has more recently used a modern prosthesis to climb Mount Kilimanjaro.

The immeasurable benefits of such technology go far beyond making those who have lost limbs more mobile. They do even more to improve their morale, independence, sense of accomplishment and self-est seem. The downside is the enormous cost, around $30,000, for an advanced prothesis. While the military may provide multiple specialized protheses to wounded warriors, civilians with good insurance may get just one, and those without insurance or sufficient income do without. That's another anomaly of health care gaps for Americans to address.

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