ABSTRACT
This chapter reviews advances in the management of often extremely complex upper and lower limb wounds arising from Operations Telic and Herrick at the different echelons of care, with a review of current and future research areas. A study looking at the change in pattern of amputations showed that there was a significant difference between the limb trauma seen in Iraq and that from the later years of the conflict in Afghanistan. These injuries reflected a change in the weapons deployed against the troops and in particular the increased use of improvised explosive devices (IEDs). The close-proximity blast wound caused by a dismounted IED was the UK signature injury from the Afghanistan conflict. The conflicts in Iraq and Afghanistan have refocused attention on combat casualty care and in particular on the impact of far forward resuscitation, prompt evacuation, haemorrhage control and time-limited surgery on patient outcome.
