Army Major Ed Flip Klein is an outdoorsman. Born in Arkansas, the 35 -year-old always determined a calming presence in nature, but when he was severely injured during a 2012 deployment to Afghanistan, he wasnt sure hed ever find that calm again.

In October 2012, Klein was a company commander in his seventh month of a nine-month deployment and out on patrol with one of his platoons. The troops split in two, and were walking through a compound with a mine detection K-9 and policeman, who intersected over an improvised explosive device( IED) before Klein unknowingly stepped on it with his left foot and it detonated.

A medivac was called and an emergency plan that Klein had helped craft weeks earlier saw him taken from the point of his injury to a helicopter, and transported to the Kandahar Regional Military Hospital inside the so-called golden hour. The golden hour refers to the time period lasting for one hour or less following a traumatic injury in which there is the highest likelihood that prompt medical treatment will avoid death.

For the nine days following the explosion, Klein would remain unconscious, and unable to reach Walter Reed National Military Medical Center in Bethesda, Maryland, due to his unstable medical status and Hurricane Sandy battering the East Coast.

The first memory he can recall is waking up the day President Obama was elected to his second term.

Not many people prepare to come home in pieces

At Walter Reed, surgeons like Army Lt. Col. Benjamin Kyle Potter, deputy chief of orthopedic surgery, were waiting to begin their work on Klein and other extremity causality patients.

I think because of the unique nature of explosion meanders, even though weve written book chapters and papers and textbooks, its not something that you can sort of read about and understand and know how to manage until youve done it a lot, Potter, who has operated on Klein multiple times, told It requires us to be very creative to its implementation of our reconstructions.

Most of the limbs are missing when I get there, Potter told. Whether youre completing the amputation or trying to close an amputation, its about trying to give them the most functional residual extremity possible given the tissue you have to work with.

The blast cost Klein both legs above the knee, his right arm above the elbow, and three fingers on his left hand. While his left thumb and index finger remain, muscle and nerve damage infringe on their functionality.

As a soldier, I think a lot of people prepare to not come home, Klein told Not many people prepare to come home in pieces.

In 2011, limb amputations among military personnel deployed as part of Operation Freedoms Sentinel( OFS) in Afghanistan and Operation Enduring Freedom( OEF) in Afghanistan reached an all-time high. According to a Congressional Research Service report issued in August 2015, 257 of the 1,645 major extremity amputations among service members dating back to 2001 came in 2011 alone. The report classifies a major extremity amputation as loss of one or more limbs, the loss of one or more partial limbs, or the loss of one or more full or partial hands or feet.

“I think that, if you go to a faraway land and maintain me safe, and you get injured, when you come back you should have everything you need to be normal.”

– Dave Laufer, director of orthotics and prosthetics at Walter Reed National Military Medical Center

What lies ahead for patients at Walter Reed that differentiates them from most civilian amputee patients, is the immediate reintroduction to physical therapy at the Military Advanced Training Center( MATC) and community recovery. For Klein and others, insuring and interacting with other troops who have similar traumata but are further down the road of recovery serves as information sources of inspiration and motivation.

They all want to be normal

On-site physical therapy also offers an opportunity for Potter and his colleagues to follow up with patients without the hassle of making formal appointments.

I typically try to walk through[ MATC] at least twice a week, and just sort of check on the guys and gals, and see how everybody is doing and talk to the therapists, Potter told. Mostly just say hi, checking peoples hands, and sometimes you can sort of nip something in the bud, if its maintaining a small problem from becoming a big one, because certainly when we put the last sew in I dont feel like my job as a surgeon is done.

For patients like Klein, having a near-on-demand prosthetics department and 3-D medical application centre can make all the difference. Dave Laufer, director of orthotic and prosthetic service, heads a personnel that works hand-in-hand with patients and physicians to craft the perfect extremity or attachment for amputees.

When the war started, we started receiving casualties, and amputee prosthetic care was not near this end-state that it is now, Laufer told We had a lot of difficulties with matching proper devices with 23 -year-old people that wanted to go out and do what they did before they got hurt, and we continue to have those same various kinds of problems because the prosthetic industry is geared toward get someone up and able to work, and the third party reimburses are very, understandably, conservative to its implementation of what theyll allow a civilian prosthesis to use in the care of a patient.

In other words, while Walter Reed has the capacity to craft customized limbs and holders, they cannot be mass-produced by civilian companies due growing costs and limited reimbursement. From the beginning, Laufer and his squad faced an uphill battle in trying to better many of the terminal devices, which is any type of extremity that enables an amputee to connect to the world, like a hand, foot, or foot attached to a knee which then fastens to the socket.

For upper-extremity amputees, Laufer told devices are really geared toward independent activities and daily living, but not specific pastimes like angling, golfing or swimming. There are also the patients who have received meanders that did not destroy the entire extremity, but affected the functionality. On any dedicated day, his department is buzzing with new extremity attachments and designs to construct the options better.

For Laufer, the process to assistance returning soldiers get to where they want to be is fulfilling. His department has considered arm devices recreated to have the same tattoos that the soldier had before his injury, terminal devices customized to have pictures of cats and dogs, and no request, in so far, has proven to be too great.

They all want to be normal, Laufer told. I think theyre new normal they get used to that really quickly, that they have lost a extremity. But then they want to be normal for their age group. Everybody goes out and operate, or they want to go out and play tennis, they want to do everything that anybody else at their age does, and I dont think thats unreasonable .

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