Regenerative rehabilitation of catastrophic extremity injury in military conflicts and a review of recent developmental efforts

ABSTRACT

Aim of the review

This review aims to describe the current state of regenerative rehabilitation of severe military extremity injuries, and promising new therapies on the horizon.

Discussion

The nature of warfare is rapidly shifting with information operations, autonomous weapons, and the threat of full-scale peer adversary conflicts threatening to create contested environments with delayed medical evacuation to definitive care. More destructive weapons will lead to more devastating injuries, creating new challenges for limb repair and restoration. Current paradigms of delayed rehabilitation following initial stabilization, damage control surgery, and prolonged antibiotic therapy will need to shift. Advances in regenerative medicine technologies offer the possibility of treatment along the continuum of care. Regenerative rehabilitation will begin at the point of injury and require a holistic, organ-systems approach.

Conclusions

Both technological improvements and a rapidly advancing understanding of injury pathophysiology will contribute to improved limb-salvage outcomes, and shift the calculus away from early limb amputation.

KEYWORDS:

• Regenerative medicine
• rehabilitation
• trauma
• volumetric muscle loss
• product development

Acknowledgments

The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government. The products referenced in the present manuscript are representative only and do not indicate any preference or endorsement whatsoever by the U.S. Government. The authors would like to acknowledge the work of many colleagues who contributed to the improvement of the understanding of the current state of the field of traumatic limb injury, and the advancement of new solutions including all of those authors cited within this paper. They represent the vanguard on which future generations will build to care for those who fight their nations’ wars.

Disclosure statement

The authors have no actual or potential conflicts of interest to declare.