At least 14 amputees are among wounded in Boston attack

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Key Points

  • Sixty-one patients remain hospitalized after Monday’s bombing in Boston
  • At least 14 are still in critical condition
  • On average 400 traumatic amputations are performed each year in USA

Along with the three who died and the more than 170 people injured in the bombings at the Boston Marathon, a lasting image of the episode may well be those who lost legs — a total of 14 people, including two patients who lost both legs.

In an event that celebrates runners with strong limbs, these victims will face a future without at least one of theirs.

Among the three patients remaining at Boston Children’s Hospital is a 10-year-old boy whose leg was amputated and remains in critical condition. He is suffering from multiple leg injuries, says spokeswoman Erin Tornatore. Other hospitals reporting patients who underwent amputations included Massachusetts General (4), Brigham and Women’s (1); Beth Israel Deaconess Medical Center (3); and Boston Medical Center (5).

As reported by many, the lessons learned from battlefields in Iraq and Afghanistan have provided insights into better treatments that will help victims of the Boston Marathon bombing. Peter Burke, chief of trauma services at Boston Medical Center, said Thursday the hospital’s five amputees are among those who can eventually expect to live productive lives because of insights gained in war that are being applied at home.

“We’re not reinventing the wheel,” Burke said. “We’re going to use the knowledge that’s available (from recent war experience) to help our patients.”

As of Thursday, more than 170 people have been treated at 10 Boston-area hospitals in the aftermath of the marathon bombing. Fifty-seven remain hospitalized, with at least six still in critical condition.

Three people died: Krystal Campbell, 29; Lingzi Lu, 23; and Martin Richard, 8.

The injured range in age from 2 to 71. At least four children, ages 2, 5, 9 and 10, remained hospitalized.

Injuries ran the gamut, from shrapnel and debris wounds to burns and ruptured eardrums.

At Beth Israel, a number of the blast victims suffered damage to their hearing, in addition to other injuries. A detonation emits sound energy and waves that do damage to the eardrum and nerves, said Selena Heman-Ackah, medical director of otology, neurotology and audiology at the hospital.

A perforated eardrum will often grow back on its own within a month or two, so the main goal is to keep the ear dry in the meantime to prevent infection, she said. Because not enough time has passed since Monday’s blast, doctors don’t yet know if patients’ hearing loss will correct itself or not. If the tissue does not grow back on its own, surgeons can create a new eardrum by relocating tissue from elsewhere in the body.

Nerve damage may be permanent, but can be treated by hearing aids for moderate losses or cochlear implants for severe to profound losses, she said. An early course of steroids may be attempted to salvage hearing although no large studies have been performed to support its use.

Massachusetts General Hospital’s patients are recovering well, said trauma division chief George Velmahos. He expected all would survive, and no more amputations would be necessary beyond the four the hospital has already done. “I don’t think any of them is at risk anymore,” he said.

Velmahos himself operated on one of the first patients to arrive at the hospital and then helped his colleagues complete several more surgeries. “These days have taken an emotional toll on everyone,” he said.

Most surgeons see only one or two amputations brought on by trauma a year, perhaps 15 or 20 for an entire hospital. “Boston did that all in a day,” said Andrew Schmidt, president of the Orthopedic Trauma Association and a trauma surgeon at Hennepin County Medical Center in Minneapolis.

There are only about 400 amputations related to trauma that are performed in the United States each year, according to figures kept by the Major Extremity Trauma Research Consortium at Johns Hopkins University.

Amputations overall are much more common — about 150,000 a year, according to the American Academy of Orthopedic Surgeons. The vast majority are for nerve disease caused by diabetes.

Traumatic amputations in the United States are done mostly after motor vehicle crashes.

“We see people who’ve been run over by a truck, bus, train — those are the kinds of things,” said Andre Campbell, a trauma surgeon at San Francisco General Hospital.

Outcomes for amputees today are dramatically better because of what doctors have learned from injuries in the Iraq and Afghanistan wars. The Defense Department has put close to $100 million into research on trauma-related to extremities in the past decade, Schmidt said.

Amputation can take several days. The initial surgery is simply to clean the wound and remove tissue that has lost its blood supply, leaving as much as possible for later reconstruction.

The patient goes back for surgery the next day and sometimes every day for several days so the surgical team can continue to remove dying tissue. The force of an explosion’s shock wave can cause damage that isn’t immediately apparent. At that point, “you don’t make any attempt to close the wounds,” Schmidt said.

Only when it’s clear what tissue will survive does the work of planning for reconstruction begin. In the operating room, a team of doctors, including a trauma surgeon, an orthopedic surgeon and a plastic surgeon, “will have a powwow to decide what’s salvageable,” Campbell said.

Amputation no longer means a life of disability. Today many patients “can almost go back to normal,” Schmidt said. “In the military, when they have amputations below the knee, many of them can go back to active duty. Runners can run again.”

Although the attack in Boston was horrific, the fact that only three people died is “a real tribute to how truly outstanding the trauma system in that city is,” Campbell said.

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