The bombs that made Boston look like a combat zone also have brought battlefield medicine to their civilian victims. A decade of wars in Iraq and Afghanistan has sharpened skills and scalpels, leading to dramatic advances that are now being used to treat the 13 amputees and nearly a dozen other patients still fighting to keep damaged limbs.
"The only field or occupation that benefits from war is medicine," said Dr. David Cifu, rehabilitation medicine chief at the Veterans Health Administration.
Nearly 2,000 American troops have lost a leg, arm, foot or hand in Iraq or Afghanistan, and their sacrifices have led to advances in the immediate and long-term care of survivors, as well in the quality of prosthetics that are now so good that surgeons often chose them over trying to save a badly mangled leg.
Tourniquets, shunned during the Vietnam War, made a comeback in Iraq as medical personnel learned to use them properly and studies proved that they saved lives. In Boston, as on the battlefield, they did just that by preventing people from bleeding to death.
Military doctors learned and passed on to their civilian counterparts a surgical strategy of a minimal initial operation to stabilize the patient, followed by more definitive ones days later, an approach that experience showed offered the best chance to preserve tissue from large and complex leg wounds.
At the same time, wartime demand for prosthetics has led to new innovations such as sophisticated computerized knees that work better than a badly damaged leg ever would again.
"This is a clear case where all of the expertise that was gained by prosthetic manufacturers was gained from the wars. It's astonishing how well they function and the things people can do with these prostheses," said Dr. Michael Yaffe, a trauma surgeon at Beth Israel Deaconess Medical Center in Boston.
The hospital has performed amputations on three blast victims so far. Yaffe is a lieutenant colonel in the Army Reserves, and many other doctors treating Boston blast victims also have had military training.
The military partnered with the American Academy of Orthopaedic Surgeons to train doctors throughout the United States on advances learned from the wars, said Dr. Kevin Kirk, an Army lieutenant colonel who is chief orthopedic surgeon at San Antonio Military Medical Center.