A collaborative research system for functional outcomes following wartime extremity vascular injury.

V injury with hemorrhage and ischemia is a significant cause of battlefield morbidity (i.e., amputation) and mortality. Recent reports have demonstrated the rate of vascular injury in modern combat to be five times that reported in previous wars. As a result of the volume of vascular trauma incurred, management of these injury patterns is of special importance. Indeed, approaches to vascular trauma (extremity and torso) havewitnessed significant changes during the course of the current wars of Iraq and Afghanistan. Therefore, an appraisal of long-term functional outcomes is warranted. Limb salvage after extremity vascular injury has evolved through previous conflicts, benefiting from individual surgeons’ experiences, backed by epidemiologic studies with subsequent technique development, application, and refinement. As the most common injury pattern in combat, extremity trauma leads to significant morbidity in the years after wounding. Although historical estimates reported early anatomic limb salvage rates (i.e., limb present or not), the burden of injury from the Global War on Terror (GWOT) has led to a reappraisal of management strategies, including an emphasis on improving long-term functional outcome. Within civilian data systems, long-term management of vascular trauma is consistently plagued by a relative paucity of adequate follow-up, and the military experience has largely been absent since reports from Vietnam. A shift toward patient-based outcome studies after extremity injury was initiated in the civilian setting through the Lower Extremity Assessment Project (LEAP). This study identified no significant differences between those undergoing limb salvage and amputees based on injury characteristics or the presence of a limb. In contrast, analysis from LEAP suggests that the factors most likely to influence functional outcome are preinjury social characteristics, such as level of education, income, and access to health care. The Joint Theater Trauma System (JTTS) and associated Joint Theater Trauma Registry (JTTR) have afforded the opportunity to maintain faithful, demographic, and clinical records of the care provided to wounded warriors of the current wars of Iraq and Afghanistan. This database has potentiated the long-term follow-up of casualty care, making patient-based studies substantially more feasible. Despite the recognized significance of the LEAP and similar studies that focus on functional outcomes after extremity vascular injury, there is no coordinated national system. To understand the relationship between early management strategies and limb outcome, a mechanism for patient-based assessment is required. The objective of this article was to introduce a system through which casualty-based outcomes can be ascertained following wartime extremity vascular injury, which in essence is to move on from simple binary outcome data into quality metrics.