"Should we save the leg?"

Without hesitation, most will jump to the affirmative. A Soldier laid out on a stretcher, surrounded by the debris of war, will beg for it to be saved.

But will he make the same plea 10 months later as surgeries fail to bring back to life a dying limb?

A technology currently used mostly in plastic surgery can help orthopaedic surgeons determine if a limb's soft tissue is healthy enough to produce a living limb after trauma.

This was just one research finding unveiled during the 2012 William Beaumont Army Medical Center Research Day.

Captain Andrew Cleveland III, with WBAMC orthopaedics department, earned first place for his poster presentation on "Use of indocynanine green fluorescent dye video angiography in orthopaedic lower extremity trauma."

The use of the dye and video technology is commonly used by plastic surgeons. The technology helps physicians to recognize healthy tissue -- tissue displaying perfusion or delivery of blood to a capillary bed in biological tissue -- capable of surviving trauma and reattachment.

Cleveland's research project delves into the first recorded and researched use of the technology in orthopaedics. His poster displayed four cases of lower extremity trauma handled at Texas Tech University Health Science Center in El Paso, Texas, -- a Level 1 trauma center where Cleveland is also working during his residency.

"This may provide an objective variable tool to make decisions on tissue that is not going to survive," Cleveland told a panel of judges.

"It helps to answer the question 'should we amputate this leg of not.'"

Cleveland plans to submit his findings to medical journals for publication.

Captain Brian Waterman, also with WBAMC orthopaedics department, earned first place for his podium presentation on "Surgical Treatment of Chronic Exertional Compartment Syndrome of the Leg: Failure rates and postoperative disability in an active patient population."

CECS is a condition caused by exercise which results in increase tissue pressure within a limited fibro-osseous compartment. The research included 611 patients -- who underwent 754 surgeries. The average age was 28 years old and males comprised 91.8 percent of the cases studied.

Waterman's research project found that CECS is a significant contributor to lower extremity disability in the military population. Waterman was also named the WBAMC Resident Investigator of the Year.

The WBAMC Research Day featured nine research presentations and 11 poster presentations all demonstrating research pursued by staff and residents at WBAMC.

"Military medicine system still has many untapped resources that can be used to fascilitate research," said Maj. Andrew Schoenfeld, keynote speaker at Research Day.

Schoenfeld is the director of orthopaedic research, chair of the investigation review board and chief of the protocol development committee at WBAMC.

Schoenfeld, who completed his fellowship at Harvard Medical School, has been involved in research since 2004 having published or had approved for publication 77 research articles.

"Our resident research productivity is as good, or better, than most other teaching programs across the country," Schoenfeld said of the orthopeadic department at WBAMC -- which has 10 surgeons.
Schoenfeld -- who was named the 2012 WBAMC Staff/ Faculty Investigator of the Year pushed for more research by residents noting the unique setting that a military installation offers.

The military operates as a model for a closed American healthcare system. The active duty military represents a young and high-demand population. Whereas a majority of orthopaedic surgeries occur on older patients in civilian healthcare -- medical research may not be applicable to the younger demographics of military orthopaedic patients.

Conditions with high incidence in active duty populations can be rare in civilian settings.