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Anal Sphincter Reconstruction

The most complicated and challenging combat casualties that have emerged during OIF and OEF are those sustained by troops encountering buried IED’s during dismounted, unprotected walking patrols. Though the magnitude of combat blast injuries has escalated, more wounded warriors (WW) are surviving higher-energy trauma. These injured now present with traumatic bilateral lower extremity amputations with and without pelvic and perineal blast involvement called “Dismounted Complex Blast Injury” (DCBI).1 The average rate of DCBI battle field injuries was 6.69 for the Army and 28.45 for the Marines per 1000 injured. These are survivable injuries but necessitate long-term follow-up.

DCBIs need immediate emergency interventions at the battlefield to control bleeding, stabilize limbs, and decontaminate wounds. Later, poly traumas are treated and unsalvageable limbs are amputated. Within several weeks, the WW is stabilized and nonlife threatening reconstruction can begin. Our long-term goal is to return dependable, self-controlled, anal function to the devastated perineal regions of DCBI survivors.