Soldier who lost all limbs in Iraq gets double arm transplant

A soldier who lost all of his limbs in the Iraq War received double arm transplants at Johns Hopkins Hospital last month in a rare procedure that has already begun to restore some normalcy to his life.

Hopkins doctors are to speak in detail about the rare procedure performed on 26-year-old Brendan Marrocco in a press briefing today. The Army infantryman lost his arms and legs in a roadside bomb attack in 2009 becoming the first soldier of the Iraq and Afghanistan wars to lose all four limbs in combat and survive.


Lead surgeon Dr. W.P. Andrew Lee said in a phone interview that it could take a couple of years for the arms to become fully functional, but that Marrocco is already able to use a computer and has been tweeting. He is expected to be discharged from the hospital today.

"We are pleased with his progression so far and think with continued therapy he will continue to do well," Lee said.


Marrocco said at the Tuesday press briefing that with new arms it is like he has become his old self again.

"It's given me a lot of hope for the future," he said about the surgery. "I feel like I've been given a second chance."

The Staten Island, N.Y. resident is only one of seven patients in the United States to have undergone successful double arm transplants, Hopkins said. It is the first such procedure performed at Hopkins, but Lee and a team of doctors have performed other double- and single-arm transplants at the University of Pittsburgh, where he worked prior to coming to Hopkins.

The 13-hour surgery performed on Marrocco Dec. 18 involved a team of 16 surgeons. The doctors first attached the bone using metal plates and screws, Lee said. Teams of doctors then sutured the muscles and tendons and then the blood vessels using a microscope. They then repaired the nerves before attaching the skin.

"It is a very complicated procedure," Lee said. "It involves a lot of precision."

Doctors also used a new treatment to prevent Marrocco's body from rejecting the new limbs, which can sometimes happen in transplant procedures. The treatment involved infusing bone marrow cells from the donor's body. It has made it so that Marrocco doesn't have to take drugs to prevent rejection, which can sometimes damage organs and cause infections.

Fusing the bone marrow helps balance the immune system of the donor arm and the patient, Lee said.

Marrocco will participate in a study to see if bone marrow should be used routinely in transplant operations. Lead surgeon Dr. W.P. Andrew Lee said he hopes to make the procedure the new standard of care for limb and face transplants.

Marrocco was a machine gunner stationed at Forward Operating Base Summerall in Bayji, Iraq, at the time of the explosion, according to a profile of the soldier in The New York Times. He was driving an armored vehicle in a convoy on a routine mission heading back to the base. He had become a driver just a few days before and was about six months into his time in Iraq.

Four soldiers were in the vehicle at the time. Marrocco's best friend in the military, Spec. Michael J. Anaya, was killed, according to The Times. Another soldier was wounded and a fourth was unharmed.

Marrocco spent months recovering at Walter Reed Army Medical Center before moving home to Staten Island to live in a house built with donations. He has been waiting for transplants since 2010.

Marrocco used prosthetics before the transplants, something that didn't always work so smoothly. As he awaited his transplant surgeries, Marrocco told the Times that one of the first things he will do with his new arms is try and drive a stick shift.


Lee said transplanted arms are better for some patients because it allows them to feel sensation. A patient with a prosthetic has to look when he ties his shoes so that his brain will process the activity. However, Lee talked about a patient with transplanted arms who was able to tie a ponytail with her hands behind her head out of eyesight.

Transplanted arms are often better for double amputees because it allows them to become independent, Lee said. It is hard to perform simple functions with two prosthetic arms, he said. Younger patients also don't always do well with prosthetics, he said.

But Lee said he is not promoting transplanted arms for everyone.

"We are not looking to replace prosthetic completely," he said.

About 60 arm transplants have been performed around the world, Lee believes. He and his team of doctors have other patients waiting for donors and are consulting with others to see if they would make good candidates.

Lee said leg transplants have been performed in Europe, but that he believes more study should be done before it is pursued in the United States.


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