The Miracle Manufacturers: Limb Salvage and the IDEO Team

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Erin Trieb for TIME

Ryan Blanck shapes an IDEO device at the Center for the Intrepid, Brooke Army Medical Center in San Antonio,Texas.

In this week’s dead tree edition, I have a piece about a small medical team at Brooke Army Medical Center (BAMC) in San Antonio who are having incredible success helping limb salvage patients return to an active life, and many even to active duty and to combat.

That might not sound like big news. The wars in Iraq and Afghanistan have been incredible for many reasons–their length, the insane number of combat tours many troops have faced–but like all wars, they’ve given us incredible medical advancements. In 2005, Army Capt. David Rozelle became the first amputee to return to the battlefield. After losing his foot to an anti-tank mine a few months after the Iraq invasion, Rozelle trained with prosthetics and returned to active duty. When a reporter asked what would happen if his prosthetic broke, Rozelle said he always carried a spare leg in his rucksack on patrols (now that is the Battleland definition of being prepared). Dozens of soldiers have followed in his footsteps and returned to active duty and the combat zone as amputees.

For the wounded warriors whose legs were able to be saved–limb salvage patients is what they’re called–the road to recovery is often a different story. Though doctors were able to save their legs, severe damage to muscles, nerves and fused joints mean they often can’t walk without pain. I met several limb salvage patients at BAMC who could barely walk 10 feet on a carpeted floor. There are a lot of these troops: for every amputee from Iraq and Afghanistan, there are an estimated five to six limb salvage patients.

In 2009, Lieut. Co. Joe Hsu, an orthopedic surgeon, Ryan Blanck, a prosthetist and Johnny Owens, a physical therapist, saw an alarming number of wounded warriors who’d had their legs saved coming back to ask for amputations. Many were Special Operations troops, Rangers and Special Forces soldiers. They were asking to have their legs cut off so they could be outfitted with the new, advanced prosthetics and get back into the fight. “The reason why we had all these guys who wanted their legs cut off was that they wanted to run,” Owens says. For high performing troops, running separates those who can do their jobs from those who can’t.

So the team put their heads together and came up with the Return to Run Clinical Pathway. Blanck studied the Cheetah Leg prosthetic and designed what’s called the IDEO–Intrepid Dynamic Exoskeletal Orthosis. The orthotic has a footplate that fits into the shoe, a brace that stabilizes the ankle, then carbon fiber rods that run up the back of the calf to a cuff below the knee. The warriors have to learn to run on the balls of their feet, the barefoot running style, and the IDEO helps them spring forward. Blanck custom makes each IDEO, and once the warriors are outfitted, Owens takes over. He puts some of the military’s toughest troops through their paces, mixing sports medicine techniques with standard physical rehab.

The results have been astounding. The team has put 219 warriors through the program; 97 have returned to active duty. Using the braces, they’re jumping out of airplanes, fast roping out of helicopters and many have returned to the same combat zones where they were nearly killed. But for many of these driven troops, their dream is to return to their units and get back into the fight.

David, a Special Forces deputy team commander who asked that TIME not print his full name for security reasons, was a free fall parachutist before a 160 pound bomb tore through his leg in Afghanistan. After more than a year of rehab, he came to the Return to Run team. He had made up his mind that he would ask for an amputation, but after Blanck fitted him with an IDEO, he was able to run, jump, sprint and carry a rucksack again. “Two years ago they’d have cut the leg off and sent us on our way,” David says. “In times of war we have huge medical breakthroughs. I think this will be one of them. They’re manufacturing miracles there at BAMC.”