Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

How Maintaining Prosthetic Services Can Help Prepare for the Next Fight

Image of Navy Seaman Chris Krobath, a prosthetics patient at Naval Medical Center San Diego, reached for new heights on the hospital’s climbing wall as part of rehabilitation therapy. . In this photo from September 2017, Navy Seaman Chris Krobath, a prosthetics patient at Naval Medical Center San Diego, reached for new heights on the hospital’s climbing wall as part of rehabilitation therapy.

Despite the winding down of the conflicts in Afghanistan and Iraq, Military Health System services for our wounded warriors, particularly those who have lost limbs in these conflicts, remain steady and may well increase in scope during the coming years.

“We’ve got to be ready for the next conflict,” said John Shero, executive director of the Defense Department’s Extremity Trauma and Amputation Center of Excellence, or EACE, at Joint Base San Antonio-Fort Sam Houston in Texas.

“During the period that we’re in now, a time of reduced ground conflict, we’ve got to sustain our clinical skills in order to be able to take care of the next battlefield casualties.”

Shero pointed to the example of the suicide bombing at the international airport in Kabul, Afghanistan, in late August during the U.S. military’s evacuation from that country. Victims of that attack – both U.S. military active duty and Afghans – came through the military’s health care system. “We were absolutely prepared to care for those casualties,” Shero said. “But if we don’t sustain key clinical skills, we won’t be.”

The wars in Iraq and Afghanistan prompted major advancements in medical care available to individuals with amputations, explained Dr. Andrea Crunkhorn, the chief of clinical programs for EACE at the Defense Health Agency headquarters in Falls Church, Virginia.

“The DOD has really been at the front of that leap forward over the last 20 years,” Crunkhorn said.

Military medical leaders intend to build on that progress by continuing research and support for those with limb loss.

The DOD’s research and clinical services for wounded warriors are centered on three Advanced Rehabilitation Centers, known as ARCs: Walter Reed National Military Medical Center’s Military Advanced Training Center in Bethesda, Maryland; Brooke Army Medical Center’s Center for the Intrepid in San Antonio, Texas; and Naval Medical Center San Diego’s Comprehensive Combat and Complex Casualty Care (“C5”) Program in San Diego.

Those three centers, along with the EACE, form the DOD Amputation Care Network, with a primary mission to fully restore normal human function to patients who have sustained severe trauma or amputation.

These MHS facilities lead the nation in developing new technology and support for people with amputations.

“What has been so fabulous about the last 20 years has been the level of collaboration at the national level,” including civilian and academic medical institutions, Crunkhorn said.

Expanded Care

The ARC at Walter Reed recently made a contractual change with how it provides prosthetic services which Shero said he hopes "will increase the capacity and the amount of prosthetic care that is able to be delivered at Walter Reed.”

That change, however, did lead to some misinformation that services were being reduced, which was "absolutely not correct,” Shero said.

The staff at Walter Reed always remained at the ready to provide care. 

“The capability has never changed," she added. "Capacity has waxed and waned with COVID, and that’s fair across all health care systems. But we absolutely want to keep all of [our] capabilities well-rehearsed and well-practiced at all of our sites. In order to do that, we have to have patients flow through the doors.”

That means expanded opportunity for other Military Health System beneficiaries who may have lost a limb, she added.

Game-changers

The EACE aims to drive a cycle of improved care and innovative research by embedding clinically focused researchers within the ARCs.

“Our research team works right alongside the clinicians who are delivering extremity trauma and amputation care,” Shero explained. “From that, we identify the clinical gaps, address those gaps through relevant research, and then use those research findings to improve the overall process of care.”

That care includes sophisticated new procedures and products for those with missing or disfigured and painful limbs.

“What we’re seeing as a follow-on is some really nice evolution in surgical procedures and techniques,” Crunkhorn said. “We’re also seeing some progression with orthoses, and that’s important because a lot of young men and women didn’t come back with an amputation from the war, but they came back with mangled limbs.”

Orthotics differ from prosthetic devices in that they are supportive of a limb instead of a replacement for one. An example cited by both Shero and Crunkhorn is what’s known as the “IDEO,” or Intrepid Dynamic Exoskeletal Orthosis. The IDEO is a customized foot-and-ankle brace made of carbon fiber that transfers energy and relieves pain that can become so acute that many patients would rather have their foot amputated than endure it.

“It’s a life-changing orthotic,” Shero said. “Before, many of our active duty and veterans that had very severe extremity trauma saw their only choice as living with pain and disability or having an amputation. But the IDEO and other advanced orthotic devices that we have helped develop and implement are really changing that.”

Patients who were barely able to walk before “are back to running, jumping, and their full complement of requirements to remain on active duty,” he added. “It truly is a game-changer.”

The IDEO is available at all three ARCs, and some civilian organizations are using the same technology as well, Shero said.

Cutting-edge procedures

Crunkhorn said that prosthetics and orthotics are by no means the only answers for grievously wounded warriors. She cited four other ground-breaking surgical procedures for those with lost or dysfunctional limbs.

They include osseointegration, when a limb prosthesis is permanently, surgically anchored into a patient’s own bone; agonist-antagonist myoneural interface (AAMI), a modified amputation surgery that retains muscle and limb control; targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), both of which help with managing nerve input and pain in the residual limb. All of these sophisticated care options are under continual development, even as they are being implemented for those wounded warriors and others who need them.

Crunkhorn said the new procedures dovetail with two of the DHA’s key priorities – supporting a medically ready force and a ready medical force. Following up with men and women injured in combat years ago, and working with retirees and others from across the age ranges for all beneficiaries, she said this “evolving standard of care” gives ARC surgeons and other specialists the opportunity to work together to optimize outcomes.

“These are really changing the face of amputation surgery, and creating the potential for more functional outcomes following amputation,” she said.

You also may be interested in...

Article Around MHS
Aug 24, 2023

Walter Reed National Military Medical Center Performs First Robotic Bronchoscopy Within the Defense Health Agency

Walter Reed’s Interventional Pulmonology team gears up for first Robotic Bronchoscopy within the Defense Health Agency. Retired U.S. Navy Capt. Robert F. Browning (1st row 4th from left) and U.S. Navy Capt. Sean McKay (1st row 5th from left). (Photo: James Black)

Walter Reed performed the first robotic bronchoscopy procedure in the Defense Health Agency. Using the robotic bronchoscope to augment our current cutting edge cone beam CT Bronchoscopy program, Walter Reed now offers state of the art services in precision lung biopsy and early lung cancer diagnosis previously unavailable within the DHA.

Article Around MHS
Aug 23, 2023

Forward Care for the Warfighter: U.S. Army Medical Research and Development Command Talks Battlefield Countermeasures at MHSRS

Soldiers with the U.S. Army Medical Research and Development Command perform a battlefield care scenario during the MRDC 2023 Best Squad Competition at Fort A.P. Hill, Virginia, on April 11, 2023.  (Photo: Danae Johnson)

With time spent on the battlefield being an increasing reality, products to help deliver immediate prolonged care to the Warfighter are now more important than ever. A concept known well by Maj. Zachary Booms, an emergency medicine physician at the Combat Casualty Care Research Team at the U.S. Army Medical Research and Development Command's Institute ...

Article Around MHS
Aug 23, 2023

MHSRS 2023 Kicks Off with Powerful Message: Medical Readiness for the Future Fight

Team members from the U.S. Army Medical Research and Development Command's Medical Material Development Activity - Broad Spectrum Snakebite Antidote (BSSA) program, receive the Military Health System Research Symposium 2023 Outstanding Research Accomplishment award in team/program management in Kissimmee, Florida on August 14, 2023.  (Photo: Danae Johnson)

Assistant Secretary of Defense for Health Affairs Dr. Lester Martinez-López kicked off the 2023 Military Health System Research Symposium with a keynote speech on the morning of August 14, delivering powerful words to the more than 4,000 people attending the event. Weaving his heartfelt sentiments into an overall call for action, Martinez put the ...

Article Around MHS
Aug 23, 2023

Researchers Say 'Warfighters Must Train like They Fight,' Emphasizing Mental Resilience During MHSRS

Susannah Knust, a research psychologist at the Walter Reed Army Institute of Research, speaks during a 2023 Military Health System Research Symposium session on Warfighter Operational Resilience on August 17, 2023. (Photo credit: Danae Johnson, USAMRDC Public Affairs)

Nearly all military physical and field training exercises can enhance mental toughness and physical endurance, which researchers at the U.S. Army Medical Research and Development Command believe can prepare Warfighters for the future, they explained during a session on the final day of the 2023 Military Health System Research Symposium on August 17, ...

Article Around MHS
Aug 7, 2023

Naval Medical Center San Diego Uses Robotics System for Total Knee Arthroplasty

Sailors attached to Navy Medicine Readiness and Training Command in San Diego use the 3D model from the Stryker Mako system while conducting a total knee arthroplasty in the main operating room. NMRTC‘s mission is to prepare service members to deploy in support of operational forces, deliver high-quality health care services and shape the future of military medicine through education, training, and research. (Photo by U.S. Navy Mass Communication Specialist 3rd Class Raphael McCorey)

Naval Medical Center San Diego continues to lead in medical technology being the first Navy Medical Treatment Facility military hospital to conduct a total knee arthroplasty utilizing the Mako Robotics system. The Stryker Mako system is a state-of-the-art robotic arm that uses haptic technology, or commonly referred to as 3D touch, to achieve high ...

Article Around MHS
Jul 13, 2023

Entomologist Augments Warfighter Research Across Indo Pacific Region

U.S. Navy Lt. Thomas McGlynn, a medical entomologist at the Navy Entomology Center of Excellence, poses for a photo with Malaysian commissioned and noncommissioned officers, Malaysian public health officials, and researchers from the University of Malaysia Sabah during their training in Johor Bahru, Malaysia on Feb. 9. (Photo: U.S. Navy Lt. Nicholas Johnston)

Naval Medical Research Unit 2 was established during World War II in Guam to conduct applied research in support of force health protection and has operated intermittently since 1955. Currently, NAMRU-2 is located in Singapore and acts as the center of a hub-and-spoke research model in multiple southeastern Asian countries such as Vietnam, Thailand, ...

Article Around MHS
Jul 7, 2023

Fate Brings Accident Victim to Brooke Amy Medical Center for Groundbreaking Procedure

Madisyn Cardenas, center, is pictured with her family after a graduation ceremony for her sister Larissa Sanchez at Texas A&M University in Kingsville, Texas, on May 12. From left, dad Stephen Cardenas, brother Stevie Cardenas, sister Larissa Sanchez, Madisyn Cardenas, mother Jennifer Cardenas, sister Natalie Villarreal. Cardenas was severely injured in a roadside accident on Oct. 5, 2022 and brought to Brooke Army Medical Center for a groundbreaking procedure. (Photo Courtesy Department of Defense)

After being struck by a car, Madisyn Cardenas had a torn aorta, broken hip, pinky finger, pelvis, and clavicle; lacerated tongue; separated abdomen; kidney lacerations; colon tear; brain hematoma; and multiple cuts, bruises, and puncture wounds. “The scariest of all was a tear in my aorta that went undetected until my arrival at Brooke Army Medical ...

Article Around MHS
Jun 9, 2023

TriService Nursing Research Program Cultivates Medical Innovative Solution Through Evidence-Based Practice and Research

The TriService Nursing Research Program held its annual Research and Evidence-Based Dissemination Course from April 4-6, 2023 in San Antonio, Texas. (Photo by U.S. Air Force Sgt. Kelsey Martinez)

The TriService Nursing Research Program held its annual Research and Evidence-Based Dissemination Course from April 4-6, 2023 in San Antonio, Texas. This course included keynote lectures by military leaders and nationally known clinical experts, along with plenary sessions featuring research and presentations from tri-service active, National Guard ...

Skip subpage navigation
Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery