but suffice it to say, none of the trauma surgeons (civilian trained) I have worked with would agree with the assertion that any civilian trauma center sees the degree of devitalized tissue and type of wounding being seen.
Detractors aside, the military had done a phenomenal job with injuries that previously would have been thought unsurvivable. Ask any trauma director at a major civilian Level 1 who is in the know.
Couldn't agree more with these two points, but lets take a closer look.
First, the contaminated wound with extensive devitalized tissue is the iconic injury of the current conflict and probably not reproduced in a civilian setting. But what's your protocol to treat it? In-theater management is hemostasis/washout/debridement then air-evac to Landstuhl. Back at WRAMC it's serial Q3D washouts with debridement +/- VAC until there is good granulation and then STSG or plastics consult for rotational flap. Washout and VAC change is a PGY 1 case. It's an important job, but quite tedious and surgically trivial. Not usually the sort of thing a budding trauma surgeon is looking for when joining the military.
Secondly, the in-theater survival may well be better than previous conflicts ( if you completely buy the military data), but is it really because of advanced new surgical procedures or amazingly talented military surgeons? Hardly. It's probably some combination of body armor, early tourniquet use, and incredibly rapid evacuation to the highest level of care. All are important developments from the standpoint of a combat trauma system, but are largely irrelevant to the individual surgeon and his post-war practice.
My point is not that military surgeons are incompetent, or that war-time injuries are exactly like civilian trauma. It's that military surgical practice, even on the front line, is not nearly as professionally stimulating as the uninitiated think. It's day after day (after day...after day...after day) of wound washouts followed by the occasional great save or unusual case.