TYNGSBOROUGH -- Sometimes while lounging on his couch, 21-year-old Matthew Boisvert feels a sharp pain in his right foot, as if "someone is driving a stake through it," he said.
He laughed at the absurdity of it, saying, "I have no right foot!"
Boisvert's right leg was amputated at the knee in August, days after the young Marine barreled his Humvee into a booby-trap in Fallujah. By late December, 199 members of the US military fighting in Iraq had lost limbs, and the percentage of wounded troops requiring amputations is double the rate during US wars in the last century.
The nation last saw large numbers of young amputees during the Vietnam War. But for this generation of veterans, the road to recovery may be less arduous. Advances in medicine and prosthetic technology will enable these wounded personnel to recover faster and enjoy a far more active lifestyle than Vietnam veterans did, medical specialists say. The veterans' medical care system is putting the new technologies to the test, as Iraq amputees begin to filter back to their communities.
"Until this new conflict, the primary groups we worked with were older diabetic patients that faced limb loss," said Barbara Sigford, national director of physical medicine and rehabilitation for the Veterans Affairs Department, the federal agency responsible for caring for wounded military. "We now are dealing with much younger patients. They want to swim, they want to run. . . . They have a whole working life ahead of them. They're raising families."
Returning amputees from Iraq get computer-driven artifical limbs allowing greater balance and mobility. Improved surgical techniques and better medicines reduce pain and minimize the infections that plagued veterans of previous wars.
Boisvert's prosthetic leg is a streamlined, futuristic limb with hydraulic pumps visible through its clear plastic shell. Every night, he detaches it and plugs it into a wall socket to recharge its internal computer.
"There's a huge array of choices out there that there weren't 20 years ago," Sigford said. "We want to normalize their prosthetics as much as possible, so if you saw them walking down the street, you wouldn't be able to tell they had lost a limb."
Veterans Affairs officials said 199 amputations have been performed on personnel at US Army medical centers since the start of the Iraq war in March 2003.
Boisvert (pronounced Bow-VAIR) returned home last month for a holiday visit, his first taste of what his new life may hold. And as friends clamored for war stories, he related experiences few 21-year-olds can fathom.
"I think I killed over 20 people," he said. "You could see them, through your scope, 40 meters away, get hit by your bullet. Later in the day you thought, wow, I just killed someone. But it's not like they're innocent."
Boisvert is 6-foot-1 and rail-thin, with long arms and fingers and thick brown eyebrows. He speaks in a listless, teenager's monotone. He joined the military after high school in 2001, something he had long contemplated, and was placed in Fox Company, Second Battalion, First Marine Division, based in Camp Pendleton, California. He fought with the unit in Iraq at the start of the war in spring 2003 and returned for a second tour last year and was stationed in Fallujah.
One day in August he drove a Humvee on a "thunder run," a high-speed dash to draw out insurgents. By the road were several fluorescent orange cones. As he sped by at 75 miles per hour, a massive explosion shook the Humvee. A cone had concealed a remote-control bomb.
Shrapnel ripped through the floor of the vehicle. Blood shot from his leg, "like an overflowing soda bottle," Boisvert recalled. Both his right arm and leg were limp, yet the Humvee kept speeding toward a 30-foot drop into a river. With all his strength, Boisvert turned the wheel with his left hand, swinging the car 90 degrees and crashing into a giant dirt mound.
A passing convoy saw the crash and sent over a medic. Boisvert's femoral artery, a crucial blood vessel in his thigh, had been severed. He began feeling faint. He knew from the gushing blood that he had a potentially lethal injury.
"My speech slurred," he said. "I told them to let me die."
Medics applied tourniquets to his leg and his severely bleeding arm and gave him morphine.
Then the US military's rapid care system, which in Iraq has saved troops' lives more effectively than in any past war, kicked into action. He was loaded into a truck, arriving within 30 minutes at a field hospital, where a surgical team awaited.
In past wars, surgery was often far off, resulting in more of the injured dying. One in four wounded soldiers in Vietnam died; in Iraq, it is one in 10, but more of the survivors are left with disabling injuries like Boisvert's.
The surgical team outside Fallujah, closer to front lines than in any previous war, stabilized Boisvert. Hours later, a Blackhawk helicopter flew him to an Air Force base near Baghdad, and that night he was evacuated to the Army's elite Landstuhl Regional Medical Center in Germany. There, he said he repeatedly asked doctors a question: " 'What about my leg?' They never really answered."
Three days later, Boisvert was at Walter Reed Army Medical Center outside Washington, where the most gravely injured soldiers get critical care. And here he got his answer: Surgeons removed his right leg at the knee. His severely mangled leg had been without blood for too long and the tissue was dying.
The next phase for amputated soldiers involves an often grueling combination of physical and mental adjustment. To provide this care, the US increased resources for dealing with limb loss after the US war in Afghanistan in 2001. The VA put amputation care teams, consisting of physicians, prosthetics experts, and mental health therapists, at 120 of its regional hospitals, including the three in the Boston area.
In addition, prosthetic technology has advanced considerably since Vietnam, when some of the wounded still got wooden limbs. Now, those who lose arms often get the Utah3 Arm, which allows simultaneous motion in the elbow, hand and wrist, offering movement old prosthetics could not. These are coupled with the SensorSpeedHand, which has electronic sensors in the fingertips that make it easier to grip objects. For legs, there is the C-Leg, like Boisvert's, which monitors motion 50 times per second to assist with balance. New devices and modifications come out regularly.
Boisvert said he and fellow amputees often pore through prosthetic technology catalogues devising wish lists. These improvements allow amputees improved mobility over the Vietnam era, with many limbless veterans already contemplating running, skiing, and even a return to combat, according to veterans officials.
Still, living with these limbs takes considerable work. After Boisvert's surgeries, he began three hours of physical therapy daily, exercising with weights attached to his limbs. The pain was intense, and he took 40 pain pills daily. But slowly he learned to balance on the C-Leg. His gait now looks nearly normal. With jeans on, it's tough to spot his disability.
Ultimately, success for these amputees will depend on their ability to maintain a satisfying life. An April 2003 US Army Medical Corps study of Vietnam veterans with amputations found that three decades later, most had found employment, and had satisfactory personal lives, but also had faced considerable health challenges throughout life.
Boisvert plans to attend the University of Massachusetts at Lowell this fall. But competitive ice hockey, a love from childhood, is out of reach. Even walking can be arduous: After two or three days using the C-Leg, Boisvert often is in pain.
But Boisvert, who returned to Walter Reed Sunday for more surgery, is optimistic: "Every week it gets better and better. It makes me feel better about how my life is going to be."
Raja Mishra can be reached at rmishra@globe.