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Amputees benefit from innovative treatment by Navy surgeons

13 June 2023
Naval Medical Center San Diego (NMCSD) stands at the forefront of Navy Medicine innovation, being the first military hospital on the west coast to implement osseointegrated amputation surgery.“Osseointegration surgery is a technique whereby a metal implant is integrated into the patient’s bone and extends externally through an aperture, or opening,
Naval Medical Center San Diego (NMCSD) stands at the forefront of Navy Medicine innovation, being the first military hospital on the west coast to implement osseointegrated amputation surgery.

“Osseointegration surgery is a technique whereby a metal implant is integrated into the patient’s bone and extends externally through an aperture, or opening, in the skin to allow for direct attachment of a prosthesis,” said Cmdr. James Flint, Orthopedic Oncology Surgeon assigned to NMCSD. “Osseointegration surgery represents the most advanced techniques available world-wide and offers the highest level of function and wellness for warfighters and patients who have sustained amputations due to trauma and cancer. Through the collaboration of multidisciplinary experts at NMCSD, University of California San Diego Health, VA system, and civilian partners, San Diego is rapidly becoming known for excellence in amputee care.”

The San Diego osseointegration program emerged from the Department of Defense’s osseointegration program at Walter Reed National Military Medical Center and brings together a multi-center, multi-disciplinary team, with experts in Orthopedic Surgery, Plastic Surgery, Prosthetics, and Rehabilitation.

“Through a multidisciplinary approach, we tailor this cutting-edge technology to advance the reconstructive care and rehabilitation of our amputee patients” said Cmdr. Yan Ortiz-Pomales, Specialty Leader for Plastic Surgery assigned to NMCSD.

“With so many amputees nationwide, many with service-connected injuries, it was apparent that a west-coast program was essential,” added Flint.

The procedure gives patients a more personalized prosthetic, in that it attaches directly to their bone, providing utmost patient satisfaction and increased prosthetic utilization, according to Flint. By offering osseointegration surgery, NMCSD provides better and more personalized patient care and greater possibilities to those who would otherwise experience limitations.

“The procedure has taken guys who previously were not successful ambulators with a traditional socket and allowed them to be successful,” said Nathaniel Leoncio, Lead Prosthetist and first primary osseointegrated transfemoral amputee at NMCSD. “It has increased an amputee’s physical capabilities, and for some it has changed their lives dramatically!”

Advantages to this surgery include elimination of socket-related complications, including skin irritation and breakdown, poor fit, multiple revisions, and more frequent visits to the prosthetist. Additional advantages are improved biomechanics and proprioceptive feedback, faster prosthesis attachment and removal, improved comfort, increased range of motion and limb strength. 

“Osseointegration grants patients advanced proprioceptive, or spatial, feedback and control of their limb, allows for simple attachment and removal of a prosthetic limb in as little as ten seconds, and bypasses the need for a traditional liner and socket altogether,” remarked Flint. “Only a handful of surgeons in the nation are truly specialized in this surgery, including myself and Dr. Ortiz, Plastic Surgeon, at NMCSD.”

SAN DIEGO (May. 24, 2023) Naval Medical Center San Diego's (NMCSD) Osseo-Prosthetics team, comprised of Cmdr. Yan Ortiz-Pomales, specialty leader for Plastic Surgery in the Navy, left, Nathaniel Ortiz, Lead Prosthetist, center, and Cmdr. James Flint, NMCSD Orthopedic Oncology Surgeon, right, pose for a group photo. NMCSD's mission is to prepare service members to deploy in support of operational forces, deliver high quality healthcare services and shape the future of military medicine through education, training and research. NMCSD employs more than 6,000 active duty military personnel, civilians and contractors in Southern California to provide patients with world-class care anytime, anywhere. (U.S. Navy photo by Mass Communication Specialist Seaman Raphael McCorey)
SAN DIEGO (May. 24, 2023) Naval Medical Center San Diego's (NMCSD) Osseo-Prosthetics team, comprised of Cmdr. Yan Ortiz-Pomales, specialty leader for Plastic Surgery in the Navy, left, Nathaniel Ortiz, Lead Prosthetist, center, and Cmdr. James Flint, NMCSD Orthopedic Oncology Surgeon, right, pose for a group photo. NMCSD's mission is to prepare service members to deploy in support of operational forces, deliver high quality healthcare services and shape the future of military medicine through education, training and research. NMCSD employs more than 6,000 active duty military personnel, civilians and contractors in Southern California to provide patients with world-class care anytime, anywhere. (U.S. Navy photo by Mass Communication Specialist Seaman Raphael McCorey)
SAN DIEGO (May. 24, 2023) Naval Medical Center San Diego's (NMCSD) Osseo-Prosthetics team, comprised of Cmdr. Yan Ortiz-Pomales, specialty leader for Plastic Surgery in the Navy, left, Nathaniel Ortiz, Lead Prosthetist, center, and Cmdr. James Flint, NMCSD Orthopedic Oncology Surgeon, right, pose for a group photo. NMCSD's mission is to prepare service members to deploy in support of operational forces, deliver high quality healthcare services and shape the future of military medicine through education, training and research. NMCSD employs more than 6,000 active duty military personnel, civilians and contractors in Southern California to provide patients with world-class care anytime, anywhere. (U.S. Navy photo by Mass Communication Specialist Seaman Raphael McCorey)
NMRTC San Diego's Osseo-Prosthetics Team
SAN DIEGO (May. 24, 2023) Naval Medical Center San Diego's (NMCSD) Osseo-Prosthetics team, comprised of Cmdr. Yan Ortiz-Pomales, specialty leader for Plastic Surgery in the Navy, left, Nathaniel Ortiz, Lead Prosthetist, center, and Cmdr. James Flint, NMCSD Orthopedic Oncology Surgeon, right, pose for a group photo. NMCSD's mission is to prepare service members to deploy in support of operational forces, deliver high quality healthcare services and shape the future of military medicine through education, training and research. NMCSD employs more than 6,000 active duty military personnel, civilians and contractors in Southern California to provide patients with world-class care anytime, anywhere. (U.S. Navy photo by Mass Communication Specialist Seaman Raphael McCorey)
Photo By: Mass Communication Specialist Seaman Raphael McCorey
VIRIN: 230524-N-XB470-1014


For patients considering osseointegration, they first meet with the multi-disciplinary team to ensure they meet the criteria for successful surgery. Options are discussed, covering differing types of implants available, including the nation’s only Food and Drug Administration approved osseointegration device.

“Once the patient is deemed a candidate, the doctors recommend a treatment plan to ensure optimal conditions for the patient to receive the implant,” said Leoncio. “For the FDA approved device, the patient will undergo two surgeries, three to six months apart. The first surgery has the implant placed into the patient’s bone, and the second will place the abutment (attachment for prosthesis) and securely affix the muscle and the skin to ensure proper functional control. The patient will typically be in therapy before and after each surgery, to strengthen the bone and ensure the patient is in the best physical health to start ambulating with an osseointegrated prosthesis. The demand on the patient’s muscles is greater than a traditional socket prosthesis, as more muscle groups are recruited for prosthetic control, similar to a native leg.”

As someone who personally utilizes the osseointegrated prosthesis, Leoncio appreciates the efficiency and ease the prosthesis provides.

“It is the simple pleasures,” said Leoncio. “I love being able to stand in the shower on two legs, I could do this before but still needed to remove the socket to wash the stump, so I never did. Because the Above Knee Prosthetic socket goes very high into the groin and captures the sitting bone it is not the most comfortable, it’s not terrible but not comfortable, I am so much more comfortable now. The prosthesis feels like a part of me now.”

For beneficiaries interested in learning more about this innovative procedure visit: https://sandiego.tricare.mil/Health-Services/Specialty-Care/Comprehensive-Combat-and-Complex-Casualty-Care/Prosthetics or call (619) 532-6044.

NMCSD's mission is to prepare service members to deploy in support of operational forces, deliver high quality healthcare services and shape the future of military medicine through education, training and research. NMCSD employs more than 6,000 active duty military personnel, civilians and contractors in Southern California to provide patients with world-class care anytime, anywhere. (U.S. Navy story by Mass Communication Specialist 3rd Class Raphael McCorey) 
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