BBC: Frontline Medicine

This programme contains some strong language from the start

and some scenes which some viewers may find upsetting

The survival rate amongst injured troops in Afghanistan is the highest in the history of combat.

Wound on the right thigh. There's a massive wound on the right thigh.

Really brilliant surgery. Undoubtedly saved this one.

But keeping them alive is just the beginning.

These unexpected survivors often have dreadful injuries.

They're young and they have a lifetime ahead of them.

'I want to see what medical science is doing to help them rebuild their lives...'

Can you imagine yourself back in Afghanistan? Yeah, that's my job. That's what I do.

'..from extraordinary prosthetics to growing spare body parts.'

This doesn't look like the beginning of a scientific revolution, does it?

'I want to find out how the conflict is driving areas of innovation that could help many of us.

'From hand transplants...'

There's something extraordinary about the idea that this was once on somebody else.

'..to giving this man an entirely new face.'

As I chat to you, I forget that this face came from somebody who died.

Earlier this year I was in Camp Bastion in Afghanistan.

I saw lots of troops brought in with horrific injuries.

The injuries are: left below-knee, right below-knee with tissue damage up to the groin.

When I was training as a doctor

I saw some pretty terrible things, so I thought I was hardened.

But the fact they were all so young really got to me.

Like Corporal Chuck Donnelly, brought in with his left foot barely attached.

Suffered from an IED blast, approximately 45 minutes ago.

Do you know what happened?

I stepped on a fuckin' IED.

He's probably the same age as my son, Alex. 20.

It's really upsetting. Really, really upsetting. These guys are so young. Really young.

I was deeply affected by what had happened to him and to many others.

Now I'm travelling to America to catch up with Chuck, but also

to find out how this conflict is driving medical research.

When I last saw Chuck it was touch and go whether he'd be able to keep his left foot.

So I'm really keen to see how he's getting on.

Hi, Chuck. Hi, Michael, how are you doing? Very good. Very nice to see you. Great to see you as well.

I have to say you're looking fantastic.

Thank you very much. The last time I saw you, you were not looking great. It was a rough patch.

But you lost a leg. It wasn't going to be too conducive to keep it,

so we made the decision to have it come off.

How did you decide? It was a no-brainer. They told me that the injury was so extensive that

it was going to be 6-12 months before they could even start repairing the foot,

and then there would be time for healing, so they told me

it would be about a year before I'd be able to stand on it.

And that's barring any infections.

You want to get back to where you were. You want to be able to run, play sports,

and once I got my leg cut off I was up walking around three weeks later.

It was an ideal choice for me.

How's this one, then? The difficulty with this leg is it's always at a 90 degree.

That's where I run into trouble, doing sports, things like that.

I have no flexion.

Is it tiring? They say it takes 40% more energy to walk with a prosthetic.

If I walk around on an average day I won't even notice.

If I do something really strenuous or spend a lot of time on my feet it gets tired quickly.

When I saw you before you weren't in a great place. It was a rough patch there!

'I was really shocked to see that Chuck had lost his leg.

'But I was also very impressed at how determined he is not to let his injury hold him back.

'Chuck is one of many.

'Because of he widespread use of IEDs -

'Improvised Explosive Devices -

'in Afghanistan, the number of amputees has risen dramatically in recent years.'

This is the Walter Reed National Military Medical Centre.

It is a vast military hospital.

You see a lot of soldiers wandering around here.

Also a lot of people missing limbs.

'Last year the number of American troops that lost limbs in Afghanistan doubled.

'I've come to meet head of amputee care Chuck Scoville.'

It's striking, isn't it? You see all these fit young guns,

but they just happen to be missing a limb, two limbs or three limbs.

To me they're kids.

They're young kids and they're just doing the things that young kids do.

Very similar age to... I've got three boys and a girl,

very similar ages to the older ones. 19, 20.

Morning. Hey, how are you doing?

'Sgt Adam Jacks lost his right leg four months ago.'

Pretty smooth. How far have you got to go?

I usually do about five to eight miles. What's the next stage?

Continuing my physical therapy and things like that.

Once I'm cleared, I do plan on returning back to my unit

and training with my Marines again.

Can you imagine yourself back in Afghanistan?

Yeah, I want to go back, that's my job, that's what I do.

So without war and things like that I wouldn't have no job.

'Despite their injuries, it seems that these guys have

'no intention of giving up their active lives.'

Do you think there's a difference between military patients

and civilian patients?

For the majority of patients, yes. Our military population is a young, active population.

Their desires and goals are to return to a very high level of function.

The vast majority of patients on the civilian side

are an older, often diabetic-disease population.

So their goals and aspirations are sometimes different than the population we deal with.

'I do admire the way the troops have such high expectations of themselves and their prosthetics.'

Good morning. How are you? Good.

'Captain Bergan Flannigan was injured in February 2010.'

Is this is your morning ritual?

Yeah, just water and alcohol, just so it slides on easier.

How's this one, then? It can do anything you want.

Especially this one. I only wish it was a little lighter.

when I put my combat boots on, it adds a little and when I'm in uniform it's definitely harder to walk in.

What happened? I was hit by an IED. We were dismounted on a patrol with the Afghan Police.

As I walked by a motorcycle it blew up.

Soon as they picked me up and put me on a stretcher, I saw my foot fall on the ground.

I was like, "Oh, I'm going home!"

Can I see you in action? Yeah, sure.

Do you try out different sorts of legs?

To find one that suits? This is my fourth one I've tried.

I've tried two mechanical knees. I liked them, but you definitely have to watch how you're walking.

If you're just casually walking and you catch something, you're doing down flat on your face.

Not a good look! No, I've done that a lot!

'These troops have the best artificial limbs there are.

'Even so, they have limitations.

'There is constant demand for better.

'The large numbers of wounded and the extreme nature of their injuries

'has resulted in the military investing huge amounts of money on new treatments and technologies.'

The US Department of Defence are spending an awful lot of money

on medical research and development.

According to this website they're going to spend nearly $640 million alone this year.

The research they're mainly interested in is the practical stuff that can be got from the laboratory

to the patient as quickly as possible.

'And much of that money is going into improving prosthetics.

'I'm at the Massachusetts Institute of Technology to meet Professor Hugh Herr,

'who believes artificial legs could one day be as good as real ones.'

Morning. Hi there, Hugh.

Michael Mosley.

Hello, Michael. Hello, I have come to see your legs. Fantastic, hopefully me as well.

Absolutely! Can I have a look? Sure.

This is the world's first bionic lower limb.

'When he was l7, Hugh lost his legs in a climbing accident.

'so he has a very personal interest in hi-tech prosthetics.'

It's a beautiful piece of engineering, I must admit.

Let me chat about how it's attached.

When I push this button, the leg comes off.

So I can just pop it off.

Would you like to...

Thank you. Oh, that's heavy.

Can you talk me through it?

There's a motorised system in here that moves the ankle joint,

and this is just packed full of electronics.

There's various computers and sensors inside.

'It's normally hard work walking with a prosthetic.

'But Hugh's systems mimics the actions

'of the muscles and tendons in a human leg.'

Can we just stroll around? Sure, if you give me my leg back!

That is very neat.

Do you think you can keep up?

MICHAEL LAUGHS

Wow, you're going so fast!

Slightly squeaky sound.

Yeah, a bit.

Very impressive! Right.

'Hugh understands only too well

'the limitations of standard prosthetics.'

There are three problems that amputees face.

One is they walk with more energy so they're more tired at the end of the day.

The second is they walk more slowly.

The third is their stability is arrested.

It's not uncommon for amputees to fall.

So this device allows the amputees to walk with normal energy levels.

We've shown it scientifically.

It allows people to walk at normal speeds, we've shown it.

And it improves stability.

'Hugh's new leg not only reduces the energy it takes to walk,

'it also helps with balance,

'detecting what angle the foot should be when it hits the ground.'

So what happens when you're walking on stairs?

Can you describe it to me?

There's five computers and 12 sensors.

One of the sensors on board is called an inertial measurement unit.

It was originally developed for missile technology, missile navigation,

and we're using it on board to determine what speed the person's walking at,

what the terrain is.

So the sensor actually tells the computers the orientation,

the positions of the limb in space.

From those positions we can determine, are they stepping up a step,

are they on level surface or a slope? What's the angle of the slope?

The computers adjust the output of the muscle-like motor system appropriately,

giving the person more energy and more stiffness. Right.

'This project has been part-financed by the military,

'which has, so far, invested $7 million.'

How much difference has military funding made to the development of this sort of thing?

Tremendous difference.

Before the conflicts in Iraq and Afghanistan I had to struggle

to get even a modest amount of money for research.

So if there hadn't been the conflicts it would have happened but much more slowly?

Much, much more slowly.

This is just the beginning. It's going to get far more interesting.

Next we'll build a bionic knee, which we'll attach to this.

Ultimately we'll have an ankle and foot that fully articulates

so we can take over completely the balance of the amputee's body.

So this is just a modest beginning.

Imagine where we'll be in 20 years.

'US troops get this new design of artificial leg free.'

They hope soon to be able to make it available to civilians,

albeit at a fairly hefty price.

I think that Hugh's feet are incredibly impressive.

To be able to replicate the human feet in that way

has required a lot of expertise and an awful lot of money.

Now, some of it has come from the private sector

but the thing that's really driving it is military funding.

When I was in Afghanistan, I saw quite a number of young men