Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project.

BACKGROUND: In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described. MATERIALS AND METHODS: The Department of Defense Trauma Registry was queried from October 2001 through August 2013 to identify all surviving US male service members with GU injuries sustained in OEF/OIF. Genitourinary injury was defined as sustaining one or more injuries to any organ or structure within the genitourinary and/or reproductive system(s) based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was quantified based on Abbreviated Injury Scale scores and overall Injury Severity Scores. The incidence, nature, and severity of GU injuries and extremity amputations are described. RESULTS: Of the 1,367 service members with GU injury included in this analysis, 433 (31.7%) had one or more extremity amputations. Most GU injuries were to the external genitalia [scrotum (55.6%), testes (33.0%), penis (31.0%), and urethra (9.1%)] vs. the kidneys (21.1%). Those with amputation(s) had greater GU injury severity (Abbreviated Injury Scale score ≥ 3) than those without amputations (50.1% vs. 30.5%, respectively; p < 0.0001). Approximately 3.4% of male service members with GU injury had an upper extremity amputation only, 8.9% had both lower and upper extremity amputation(s), and 19.4% had lower extremity amputation(s) only. Of the 387 patients with GU injury and lower extremity amputations, 87 (22.5%) had amputations below the knee and 300 (77.5%) had amputation(s) at/above the knee. CONCLUSION: In OEF/OIF, concomitant GU injury and extremity amputation are common and have serious implications for health and quality of life. This wounding pattern presents new challenges to the military medical and research and development communities to prevent, mitigate, and treat these battlefield injuries. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.

The development and introduction of ballistic protection of the external genitalia and perineum.

In response to an Urgent Operational Requirement, the UK Ministry of Defence (MoD) investigated, designed, developed, trialled and subsequently fielded a Tiered Pelvic Protection System to service personnel deployed on Operation HERRICK in Afghanistan. An Urgent Statement of User Requirement (USUR) was drafted in order to equip service personnel with protection for the groin, perineum, buttocks and upper thigh areas from the effects of buried Improvised Explosive Devices (IEDs). Injuries to the groin and pelvic area from buried IEDs can have severe physiological and psychological impact; therefore the aim of the pelvic protection was to reduce the number and severity of such injuries and to improve the outcome, both in terms of quality of life of the survivors and increase the chances of survival. The aim of this paper is to outline some of the research and development that contributed to the design(s) of the Tiered Pelvic Protection System; describe the components of, and report the medical success of, the Tiered Pelvic Protection System.