WRNMMC, Bethesda, Md.   –   Researchers from Walter Reed National Military Medical Center earned top awards in the 38th Annual Navy-wide Academic Research Competition held May 16 at Navy Medicine Readiness and Training Command (NMRTC), Portsmouth, Virginia.
In addition to Walter Reed and Portsmouth, researchers from NMRTC San Diego presented their work as part of the competition.

Pawel Golyski, a medical research scientist at WRNMMC, earned first place in the Basic Science or Animal Research Staff Category for his work on whether a prosthetic foot type influences intact limb knee load in individuals with unilateral transtibial amputation.”

“Individuals with transtibial amputation are at a 17-times higher risk of intact limb knee osteoarthritis, and 30 percent more likely to have intact limb knee pain,” Golyski explained. “Advanced prosthetic foot designs can mimic the biological foot to potentially reduce reliance on the intact limb. However, comparison between powered and passive energy storing and returning devices do not definitely show reduced intact limb knee loads during walking.”

In the Clinical Research Staff Category, Navy Lt. Cmdr. (Dr.) Sara Drayer, of gynecologic oncology at Walter Reed, earned first place for researching “the effects of regional nerve blocks on intraoperative and immediate post-operative opiate requirements in patients undergoing laparoscopic hysterectomy.”

“This review aims to examine the utility of pre-induction regional anesthetic blockade on intra-operative and immediate post-operative opioid consumption in individuals undergoing laparoscopic hysterectomy for any indication,” Drayer explained. “Women are twice as likely to be prescribed opioids compared to men, and death related to opioid overdose has increased at a more rapid rate in women. Gynecologic enhanced recovery after surgery pathways aims to reduce post-operative narcotic use through multimodal pain regimens and pre-surgical anesthetic adjuncts,” she added.

Army Capt. (Dr.) Colin Harrington, of Walter Reed’s orthopedics, placed second in the Clinical Research Trainee Category, for his research “Conversion to amputation for combat-related extremity injuries treated with flap-based limb salvage during the recent wars in Afghanistan and Iraq.”

“Success in limb salvage has often been defined by an intact limb at initial discharge. However, clinical experience suggests that even successfully salvaged limbs remain at significant risk for subsequent amputation due to late complications, chronic pain, or unsatisfactory impaired function. We sought to define the rate and primary drivers behind early and late amputation following flap-based limb salvage in combat extremity trauma,” Harrington stated.

Harrington added the study highlighted that “a subset of patients ultimately requires major limb amputation despite having achieved what is initially considered successful limb salvage. Flap-related complications, vascular injury, and lower extremity site of injury were associated with early amputation after successful expeditionary efforts at limb preservation.
Conversion to late amputation was associated with lower extremity periarticular fractures and fractures nonunion. Chronic pain and persistent limb dysfunction were the most common drivers of late amputation.”

Navy Lt. Jeremy Tran, an orthopedic resident at Walter Reed, placed third in the Basic Science or Animal Research Trainee Category for his work, “Biomechanical Comparison of C3 Dome Laminotomy Versus Open-Door Plate Laminoplasty.”

Tran explained that “cervical laminoplasty is a common surgical procedure used for decompressing the spinal cord to treat cervical myelopathy and stenosis, particularly in disease requiring multi-level decompression where anterior approaches are not suitable. However, performing an open-door laminoplasty at cervical 3 (C3) requires extensive dissection of the semispinalis cervicalis muscle insertion, leading to postoperative axial neck pain and loss of range of motion.

“To avoid this, a dome laminotomy can be performed at C3 instead, with laminoplasties performed throughout the remainder of the decompressed levels. This also allows for decreased instrumentation, smaller surgical exposure, and less muscular dissection.

“While both procedures at C3 provide adequate decompression of the neural elements, differences in postoperative cervical range of motion between the two remain unclear. Based on our biomechanical model, there is no significant difference in changes in cervical range of motion between dome laminotomy and open-door laminoplasty at C3 when performed in conjunction with C4-C6 laminoplasties,” Tran added.

Some of the other projects in this year’s Navy-wide competition looked at social factors increasing the risk for mental health conditions resulting in separation from the U.S. Navy; race has no impact on rates of surgical complications at military medical treatment facilities (MTFs); perceptions of general surgery residents at MTFs; and point-of-care assessment of coagulation status in a model of trauma-induced coagulopathy.

“All of the research and presentations were of high quality, and selecting the winners was no easy task for the judges. This invaluable work and effort are inspiring and show the dedication our clinicians have to learning, teaching and mentoring the next generation and improving the health, readiness and resiliency of those we are so privileged to care for. All of this work is done above and beyond our usual duties because of the dedication and drive of the talented people we serve with,” stated Navy Capt. (Dr.) Brian Feldman, commander of the Navy and Marine Corps Public Health Center at Portsmouth, host for the competition.