Scarless Wound Healing

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Sandeep Kathju, PhD

Allegheny-Singer Research Institute

The extremities of the human organism rely upon a complicated interaction between muscles, tendons, and bones/joints to enable movement. Injury to the extremities resulting in scar can severely compromise that movement, rendering the limb useless and possibly incapacitating the affected individual. The recent combat experience of the U.S. military demonstrates that extremity injury is presently one of the most common medical problems confronting the U.S. medical corps. Thus, this research is aimed at developing strategies to reduce scar, can only be regarded as of profound significance to the U.S. military.
   
Carey, reviewing the wounds incurred by U.S. Army Seventh Corps personnel in Operation Desert Storm, noted that, of 143 soldiers who received ballistic injury, 90% had extremity wounds.  More recently still, several reports have surveyed the U.S. military’s medical experience in Operation Enduring Freedom. The 102nd Forward Surgical Team, reviewing their operative experience at Kandahar Airfield from August 2002 to March 2003, and including Afghan militia and civilians as well as coalition forces, found that extremity wounds were their leading causes for surgery (44%). The 274th Forward Surgical Team, based at Bagram, reviewing combat injuries only, reported that “by far the most common site of wounding was the extremities, accounting for 59% of wounds.”
   
The predominance of extremity wounds is reported to continue in Operation Iraqi Freedom. Alpha Surgical Company, deployed with the 1st Marine Expeditionary Force, noted that extremity wounds constituted 51% of the combat injuries they treated. Most of these injuries were caused by explosive munitions, and required operative debridement and/or external fixation. Gondusky and Reiter examined the injuries sustained by a mechanized battalion assigned to protect military convoys travelling in Iraq. They found that upper extremity and head injuries were common (70%), whereas lower extremity injuries were rarer (11%). They concluded that “shoulder and axilla protectors may be beneficial, but lower arm and hand injuries remain difficult to combat.” These are precisely the areas most vulnerable to crippling musculotendinous injury and scar formation. This same experience was mirrored in British forces; the 34 Field Hospital in Iraq reported that 55% of their combat casualties underwent surgery for injury to the extremities^{. They concluded that “extremity injuries do confer a high surgical workload in war. Surgical resources should, therefore, be aimed at this and surgical teams deployed to such environments should be well versed in the surgical management of casualties with limb trauma.”
   
This research represents an attempt to understand the molecular basis of scar formation, the major complicating factor of musculotendinous injury to the extremities, so that adjunctive molecular therapies to surgery might be developed. As such we submit that this work is of extreme significance to the military, as well as having enormous relevance to the civilian world.}