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To determine rates of major limb amputation in U.S. military casualties in the current conflicts in Afghanistan and Iraq, to correlate these with mechanism of injury, and compare the rate with that seen in U.S. casualties from the Vietnam War.Retrospective study of all U.S. casualties recorded for the current conflicts from the start in October 1, 2001 to June 1, 2006.Records from U.S. military forward surgical teams (Level IIb) and combat support hospitals (Level III) in theater, evacuation (Level IV, Germany), and major military medical centers (Level V, United States).All recorded U.S. military casualties from the Afghanistan and Iraq theaters with injuries requiring evacuation out of theater or prohibiting the individual from returning to duty for more than 72 hours.None.Major limb injury, level of amputation, principal mechanism of injury.Over the past 56 months, of the 8058 military casualties meeting the listed criteria, 5684 (70.5%) were recorded as having major limb injuries. Of these, 423 (5.2% of all serious injuries; 7.4% of major limb injuries) underwent major limb amputation or amputation at or proximal to the wrist or ankle joint. The mechanism of injury for 87.9% was some form of explosive device. The major amputation rate during Vietnam was 8.3% of major limb injuries.Overall, major limb amputation rates for the current U.S. engagement in Afghanistan and Iraq are similar to those of previous conflicts.