Author Question: Amputations and Infections

Kariss Asks:

A Navy SEAL team is on a mission in Ukraine. One of the guys gets shot in the leg by a sniper and then gets debris in his leg when the boat explodes. They dive into the Black Sea to get away before getting to the getaway boat. He is sent to a military hospital in Germany and then sent back stateside to make decisions with his wife. In the story, I need him to have his leg amputated but also be a potential candidate for a bionic leg/prosthetic down the road.

A few questions in that regard…where would he need to get shot in the leg for that to be an issue? I thought a major artery. But I'm not sure that is accurate. Would infection be a problem from the dirty water and wound? If so, how long would that take to set in? Since I need amputation to be the final outcome, how long would doctors deliberate and monitor issues before choosing to amputate? I think my timeline may be too long in the book and I want this to be accurate.

Also, I have one of the SEALs call the wounded warrior's wife to let her know there is a problem and they are coming home. Because of mission sensitivity, he can't tell her what happened, especially over the phone. My editor thinks a doctor would be the one to contact the wife instead of someone on the team. But I'm not sure that would be true in the case of classified special forces ops. Any input on this?

Jordyn Says:

Thanks for your question. It's an excellent one and I've pulled in several people to help so thanks Tim (who serves as a military chaplain) and Angelique (a physician co-worker) for your insights.

Question #1: There are many indications for amputation-- only one being lack of blood flow to the extremity. So damage to a major artery doesn't necessarily have to be your mechanism of injury. Top three reasons would be trauma (the extremity has lost too much muscle, bone, etc), infection, and vascular insufficiency (damage to the blood supply that keeps the tissue alive.)

Question #2: Is infection a concern because he was swimming in gross swamp water? Yes, this will be a concern. Infection could show up in as little as 12 hours. More commonly is 48 hours. Of course, there are always outliers. What you could research is common skin infections, microorganisms, and such in the geographical area your incident happens. You might find something better that fits your time frame.

Question #3: How long would the doctors take to make a decision? Here, you could basically make the medical scenario fit your timeline. If you want them to amputate right away-- go with major loss of tissue from the extremity. It's basically not salvageable. Or-- longer (days to weeks) then you could use a scenario where infection sets in, he doesn't initially respond to the antibiotics, they try a different antibiotic-- maybe surgical debridement, etc. That process could take a week or more.

Question #4: Notification. This is directly from the chaplain's e-mail to my query.

I can only speak based on my experience in the Navy, and please recognize that the various military branches handle casualty notifications in different manners. That being said, a doctor would not be the one to call giving the nature of the incident. A command representative in addition to a chaplain would generally make an in person visit to the primary next of kin, in this case, the spouse. Also, if this is really a soldier, then he's Army, whereas, the other branches would refer to themselves as Airmen, Sailors, or Marines. 

As a side note, in discussing your question with the physician, she said below the knee amputations are easier to fit with a prosthetic versus an above the knee amputation so consider this as well for your story.

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Kariss Lynch began her writing career in third grade when she created a story about a magical world for a class assignment. Chasing her dream into college, she received a degree in English at Texas Tech University and fell in love with writing faith-based fiction about characters with big dreams, adventurous spirits, and bold hearts. Her first novel, Shaken, book one in the Heart of a Warrior series, released in February 2014, with the second book, Shadowed, scheduled to release in Winter 2015. Kariss is a diehard Texan, born and bred in Dallas, where she now works as a writer for a local communications ministry.

The Civil War and Prosthetic Limbs: 1/2

I'm so pleased to host author Jocelyn Green again. She's an amazing woman and author of inspirational fiction surrounding the Civil War.  Jocelyn will be here over the next three weeks sharing wonderful information about her research. Often times, during war, there is a lot of advancement in medical technology which is why I'm giving her so many days.

Plus, I just love her.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood's on May 12th, 2013.

Jocelyn has also graciously said she'll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Jocelyn appeared before at Redwood's and you can read those posts here and here.

Welcome back, Jocelyn!

“It is not two years since the sight of a person who had lost one of his lower limbs was an infrequent occurrence. Now, alas! There are few of us who have not a cripple among our friends, if not in our own families. A mechanical art which provided for an occasional and exceptional want has become a great and active branch of industry. War unmakes legs, and human skill must supply their places as it best may.”

~Oliver Wendell Holms, M.D., “The Human Wheel, Its Spokes and Felloes,” 1863

If necessity is the mother of invention, it should come as no surprise that the Civil War, which produced some 45,000 amputee veterans, also prompted major progress in the development and production of artificial limbs. One of the characters in my novel Widow of Gettysburg is the recipient of one of these limbs. Let’s take a closer look at what was involved in this rehabilitation of amputee veterans. (You can see more on amputations from a previous blog I wrote for Jordyn, here: http://jordynredwood.blogspot.com/2012/08/civil-war-amputations-and-anesthesia_31.html) 

Double Amputees of the Civil War

Once the stump was healed after amputation and the patient able to do without dressings, the surgeons' work was finished, and the patient was left to shift for himself in securing the best apparatus. But not everyone was a good candidate for a prosthetic. If the limb was taken off at the joint, such as the hip or shoulder, there was no stump to which an artificial limb could be attached. The surgeon may have performed the operation too high or too low on the limb for a good fit to be possible. Also, if the stump was prone to frequent infection, it would have been too painful to attach an artificial limb to it.

For those who could pursue a prosthetic, in the North, the most popular artificial leg was a “Palmer” leg, named for Benjamin Franklin Palmer, who patented the design. A previous design by James Potts was made of wood, leather, and cat-gut tendons hinging the knee and ankle joints, and dubbed “The Clapper” for the clicking sound of its motion. Palmer improved upon this design with a heel spring in 1846, and his “American leg” was produced continuously through World War 1.

Palmer’s leg cost about $150, a prohibitive amount for the average private, whose pay was about $13 per month. Add to that the cost of travel and lodging expenses to see a specialist, and the number of amputees who could afford it went down even further. The cost of an artificial limb for Confederate veterans was between $300-$500, due to the soaring inflation.

Since the majority of veterans had been farmers, planters, or skilled laborers before the war, the need for artificial limbs was, indeed, a crippling problem. To help address it, the U.S. government appropriated $15,000 in 1862 to pay for limbs for maimed soldiers and sailors. In January 1864, a civilian association in Richmond was established to pay for artificial limbs for Confederate amputees.

After the war in 1866, North Carolina became the first state to start a program for thousands

of amputees to receive artificial limbs. The program offered veterans free accommodations and transportation by rail; 1,550 veterans contacted the program by mail. During the same year, the State of Mississippi spent more than half its yearly budget providing veterans with artificial limbs.

 Return for Part II on Friday.

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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.