ABSTRACT
In response to the Coronavirus 2019 (COVID-19) pandemic, vascular surgeons in the Veteran Affairs Health Care System have been undertaking only essential cases, such as advanced critical limb ischemia. Surgical risk assessment in these patients is often complex, considers all factors known to impact short- and long-term outcomes, and the additional risk thatCOVID-19 infection could convey in this patient population is unknown. The European Centre for Disease Prevention and Control (ECDC) published risk factors (ECDC-RF) implicated in increased COVID-19 hospitalization and case-fatality which have been further evidenced by initial reports from the United States Centers for Disease Control and Prevention. CDC reports additionally indicate that African American (AA) patients have incurred disparate infection outcomes in the United States. We set forth to survey the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database over a nearly 20 year span to inform ongoing risk assessment with an estimation of the prevalence of ECDC-RF in our veteran critical limb ischemia population and investigate whether an increased COVID-19 comorbidity burden exists for AA veterans presenting for major non-traumatic amputation.
ABSTRACT
Currently, there is a paucity of patient reported outcomes (PRO) measures of secondary health effects and complications that result from neuromusculoskeletal injuries, which greatly limits the clinical care and successful rehabilitation, reintegration, and return to duty/work of injured individuals. This study will create valid, standardized, psychometrically robust, and clinically useful PRO measures for traits and symptoms relevant to understanding quality of life and the health and rehabilitation outcomes of Wounded Warriors and civilians with neuromusculoskeletal trauma. Furthermore, this study will develop clinical score reports in an actionable format to improve the clinical workflow and standard of care for individuals with traumatic limb injuries. During year three, we successfully prepared for and launched large-scale field testing. To date, 159 participants have begun baseline and 154 have completed the baseline interviews. Work to plan for data analyses is underway. We have also worked this year amid challenges from the COVID-19 pandemic, which affected our daily operations and caused the pace of recruitment to slow. However, we have established processes for remote recruitment, consenting, and data collection. We have identified several additional sites that have eligible participants and are willing to recruit them, to help increase recruitment throughput.
ABSTRACT
There is a growing population of women living with amputations, specifically in the VA and DoD healthcare system, yet little research has been performed to understand the unique needs of this population, which limits evidentiary support for clinical decision making. This investigation aims to conduct a 3-year national exploratory needs assessment that will focus on the unique physical, psychological and social needs of women living with amputations. The investigation is a collaborative effort between the VA, DoD, and civilian sector. To ensure a heterogeneous population of respondents, a convenience sample of 100 male and 100 female Veterans, Servicemembers, and civilians will be recruited from across the nation to participate. The participants will be asked to complete an online computer adaptive survey regarding their physical health, quality of life, prosthetic use and needs, and psychosocial experiences. Surveys will be completed anonymously and electronically without individually identifiable information.
ABSTRACT
In the current military and healthcare environment, it is essential to focus on rapid but safe development of functional skills with a goal of early discharge from rehabilitation to return to active duty or civilian life. Although the U.S. military has access to state-of-the-art treatment and devices, warfighters with lower extremity trauma still struggle to regain full functional capabilities. A key factor that limits the ability of these individuals to achieve maximum functional capabilities is falls. Falls have serious consequences including loss of confidence, fear of falling, and injury. Warfighters with lower extremity trauma need to face the risk of falling and overcome that fear. After standard rehabilitation for amputation or limb salvage, many warfighters still struggle with falls, which can exacerbate physical and emotional injury and delay healing. When individual strip or slip, they are likely to fall and injure themselves, in spite of advances in rehabilitation care. This project develops a secondary rehabilitation program, implemented after traditional therapy, and designed to reduce falls in warfighters with amputations or limb preservation procedures. The goals of this research effort are to augment existing rehabilitation with a novel, demonstrably successful fall-prevention training method to help warfighters return to full high-level functional capabilities and emotional wellness, and to decrease the time required to either return to active duty or to a productive, active civilian life. The training program utilizes a microprocessor-controlled treadmill designed to deliver task-specific training perturbations. The training consists of six, 30 minute sessions delivered over a 4-week period. In the current year, 35 subjects have completed training.
ABSTRACT
A majority of service members who undergo traumatic amputation develop chronic phantom or chronic residual limb pain with 10-15% of these patients developing severe, disabling, long-term pain. 30-40% of traumatic amputees, however, have no clinically significant chronic pain. We believe this dichotomy of outcome is the key to understanding the development of chronic neuropathic pain after nerve injury. Preclinical studies using rodent models have provided some insights into the pathological sequelae of nerve injury, but this knowledge has not resulted in successful translation to the clinic. Recent evidence suggests that interspecies differences are a major barrier to successful translation, since rodent sensory neurons diverge considerably from their human counterparts. Accordingly, in order to better understand the pathological processes that lead to neuropathic pain after nerve injury, it is necessary to comprehensively study injured human nerves. Our colleagues at Walter Reed National Military Medical Center spent three years obtaining sciatic nerve samples from service members undergoing primary amputation revision surgery after suffering traumatic amputation on the battlefield. These unique samples allow, for the first time, study of nerve regeneration and neuroinflammation in humans during the days following traumatic amputation. Utilizing bulk tissue and single nuclei RNA-sequencing and unbiased global proteomics of the distal portion of sciatic nerve collected 1-14 days after initial traumatic amputation, we aim to establish the distinctive transcriptional, protein and glial/immune cell profile of injured sciatic nerve during injury and regeneration.
ABSTRACT
The primary objective of this study is to evaluate Axoguard Nerve Cap in large diameter sizes (5mm -7mm) for protecting and preserving terminated large diameter nerve endings after limb trauma or amputation when immediate attention to the nerve injuries is not possible. The secondary objective of this study is to demonstrate proof-of-concept that large diameter nerve caps can prevent or reduce the formation of symptomatic neuromas in large diameter nerve endings after trauma or amputation when immediate attention to the nerve injuries is not possible.