Although a number of scoring systems to predict the need for amputation exist, none is widely accepted or validated in the combat trauma population.3 It is imperative that the combat-injured patient be adequately resuscitated and that the surgical team practices damage control surgery when required. Given the time that can be required to restore perfusion, especially in complex combat-related injuries, amputation may be a necessary damage control procedure in a massively injured patient – life over limb. Following resuscitation, adequacy of limb perfusion is the next major determinant. If the limb is adequately perfused, or perfusion can be restored expediently by shunt or repair, any decision regarding amputation due to the likelihood of having a poor functional recovery as a result of other soft tissue (i.e. nerve injury or volumetric muscle loss) or bony injury can potentially be deferred until later. The limb should be stabilized for transport by splinting or external fixation, as indicated.