Soldier's double-arm transplant a success
By The Washington Post
Published: Monday, Jan. 28, 2013, 5:56 p.m.
The nation's first soldier to survive losing all four limbs in the Iraq war has received a double-arm transplant in Johns Hopkins Hospital in Baltimore, the hospital is expected to announce on Tuesday.
Brendan Marrocco, 26, of Staten Island, N.Y., who underwent the marathon surgery last month, was the first service member from the wars in Iraq and Afghanistan to survive the loss of four limbs, officials have said.
He lost both legs above the knee, his left arm below the elbow and his right arm above the elbow when the military vehicle he was driving was struck by a roadside bomb on April 12, 2009.
He is the nation's first service member to receive a double-arm transplant, and the hospital says he is one of only seven people in the United States who have undergone successful double arm transplants.
The complex operation was performed on Dec. 18.
Later, in a new anti-rejection procedure, he received an infusion of bone marrow, derived from vertebrae harvested from the donor's lower spine. The infusion allows doctors to reduce the number of powerful anti-rejection drugs used from three to one.
That is beneficial because the anti-rejection drugs can have harmful side effects, including infection, organ damage and cancer.
The 13-hour surgery was performed by a special team of transplant experts headed by W.P. Andrew Lee, professor and chairman of the department of plastic and reconstructive surgery at the hospital.
It was the first limb transplant by his newly established group at Hopkins, the hospital said.
“He's doing well,” Marrocco's father, Alex, said Monday. “Doing well. It's been a little over a month now.”
The hospital said it would detail the operation at a news briefing on Tuesday.
The procedure was the seventh double-hand or double-arm transplant performed in the United States. Lee led three of those earlier operations when he worked at the University of Pittsburgh, including the only above-elbow transplant that had been done at the time, in 2010.
Little thus far is publicly known about Marrocco's donor, but Lee said the donor arms often are brought from another hospital, another city or another state.
Donor and recipient do not necessarily have to be of the same gender, but the limbs should match in size, skin color, and tissue and blood type.
Details are critical
In a double transplant, all four arms must be carefully readied, with the skin peeled back and the bone ends cut at angle, as a good carpenter might, for a solid connection, according to a textbook on transplantation Lee and his colleagues are writing.
Inside the arm, individual muscle tendon units, nerves and blood vessels are identified. They are then tagged with pieces of light blue sterile bandages that are sewn in place and labeled in permanent black marker to ensure proper connection.
The connecting sequence begins with the bones, which are joined with metal plates.
“It's not as easy as fixing a fracture,” Lee said, “because the two ends of the bone belong to different people.”
Next, he said, “we typically connect the muscles and tendons.”
After that, “we put together the blood vessels,” he said. “That's the critical part, where we need to restore circulation to the transplanted limb by connecting the arteries and the veins. And they're typically done under a microscope.”
Finally, the skin is sewn together.
Lee said war injuries have often resulted in amputations higher up the arm.
That is more problematic, in part, because nerves in the donor arm are dead and must be replaced by the recipient's nerves, which regenerate down the arm at a rate of about an inch a month.
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