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News Americas

The operation was performed by a team of 16 plastic, orthopedic and microvascular surgeons. (Photo courtesy of Johns Hopkins Hospital, Baltimore)
Feb 13, 2013 | News Americas

After quadruple limb amputation: Ex-soldier receives bilateral arm transplant

by Surgical Tribune

BALTIMORE, Md., USA: A U.S. surgical team has performed a bilateral arm transplant together with an innovative treatment to prevent rejection of the new limbs. The patient received a transplant of two arms from a deceased donor, becoming one of only seven people in the U.S. to have undergone successful double hand transplants.

Twenty-six-year-old infantryman Brendan M. Marrocco lost all four limbs in 2009 when he was struck by an explosively formed projectile while driving an armored vehicle in Iraq. He became the first survivor of quadruple limb amputation due to injuries sustained in the war.

The transplantation, which was performed at the Johns Hopkins Hospital in New York and sponsored by the Armed Forces Institute of Regenerative Medicine of the Department of Defense, was the most extensive and complicated limb transplant procedure ever performed in the U.S.


The 13-hour procedure was performed by a team of 16 plastic, orthopedic and microvascular surgeons from several medical institutions. On the patient's right side, the doctors carried out an above-elbow transplant, which entailed connecting the bone, muscles, blood vessels, nerves and skin. On his left side, in order to preserve the elbow joint, they transplanted all the donor forearm muscles over his remaining tissue, then rerouted the nerves to the new muscles. The artery had to be repaired such that it would provide blood to both the remaining tissue and the new arm. The surgical team had rehearsed the procedures on cadaver arms four times within the 18 months prior to the actual operation.

The patient recovered well after the surgery but the recovery process is expected to be long. Marrocco needs to take anti-rejection medication, which can have infectious or metabolic side effects. However, he is being treated according to a special immune modulation protocol developed by a medical team. As part of the protocol, the patient received the bone marrow cells from the deceased donor's arm. Thus, he only needs to take one anti-rejection drug instead of the usual triple-drug cocktail. "We have employed the same protocol successfully in previous hand transplants, and will also use it in our face transplant program at Johns Hopkins," a doctor stated.

In addition, Marrocco began intensive hand therapy a week after transplant. The therapy will continue for a few years because the nerves regenerate at a maximum speed of 1 inch per month.

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