Technological advances in plastic surgery lead to complete arm transplants for two wounded warriors

Plastic surgery has advanced considerably since its origins as a treatment for injured soldiers. From rudimentary surgeries during World War I, it has now grown to full limb transplants for troops who have lost their arms, restoring function and giving them a chance at living a more normal life.

The arms for transplants come from deceased donors whose families decide to donate the limbs to improve the quality of life of someone who needs them, like United States Army Sgt. Brendan Marrocco. It was Easter in 2009 when a roadside bomb in Iraq exploded, hitting the vehicle he was riding in.

"I was just driving around Iraq and just on our way home late at night one night and got blown up. And instantly lost my arms and legs," Marrocco said.

The infantryman lived without arms for three years, struggling to complete activities of daily life that used to be possible when he had arms. Then, in 2012 the New Yorker underwent double arm transplant surgery at The Johns Hopkins Hospital and was given new limbs.

W.P. Andrew Lee, MD, then-chair of the Department of Plastic and Reconstructive Surgery at The Johns Hopkins Hospital, led the operation. It was the hospital's first double arm transplant and marked a vital step forward in the advancement of reconstructive plastic surgery.

War and plastic surgery innovation

"Many advances in plastic surgery have come as a result of wartime injury treatment. The increased incidence of extremity amputations have resulted in transplantation for those brave wounded warriors whose lives have been transformed from the transplantation," Lee said.

United States Army National Guard Sgt. Eric Lund is another warrior to benefit from advances in reconstructive plastic surgery. Like Marrocco, he, too, lost limbs while serving his country. His loss came in 2012 when he was riding inside a vehicle during wartime.

"We were in the Kandahar province of Afghanistan doing surveillance when our vehicle hit an IED. I was told I lost both my arms," Lund said.

Both he and Marrocco underwent a complex surgery to attach donor arms where their arms had once been. The process included finding a donor arm that matched in size, skin tone and blood type.

The surgery is extensive and requires four surgical teams working simultaneously with at least three surgeons on each team – two teams working on the right side and two on the left side.

"It's a very complex type of surgery that requires the connection of bone, the connection of tendons and nerves," said Gerald Brandacher, MD, scientific director of The Johns Hopkins Hospital's Department of Plastic and Reconstructive Surgery.

Only seven people in the country had successfully undergone the operation at the time of Marrocco's surgery. The Johns Hopkins Hospital is among a small handful of institutions in the U.S. that have performed the intricate coupling of a donor's arm to a recipient.

"We bring them together, and we start by first connecting the bones to keep the transplant in place, and then structures such as the tendons, the nerves and the vessels are connected step by step until finally the transplant is finished by closing up the skin," he said.

Restoring feeling and movement

It takes a while after the arm transplant for the recipients to gain feeling and movement. The nerves generate at a rate of about one inch each month, so it can be some time before the arm gains feeling and motion. But, as Marrocco said, it does come eventually.

"The first little movements there were, you know, a month or two, probably three or four. It was just a little flicker of a finger basically because your nerves have to grow down into your arm and basically as they grow you get more and more function. It's extremely exciting to watch happen because years of my life have been leading up to the arm transplant, and to finally see it happen and then start to work. It's just been exciting," Marrocco said.

The transplanted arms will never reach 100 percent function, but the movement, mobility and dexterity they do gain is a vast improvement for both soldiers who had been living with no arms up until the time of the transplants.

"Now I feel more hope than I felt in a long time for my future. Now I have something to shoot for, goals to work towards, and life feels fulfilling," Lund said.

According to Brandacher, seeing an arm transplant patient progress with feeling and motor limb function is rewarding for him as a doctor, and so is witnessing their return to regular life.

"We have seen patients go back to school getting a degree and really getting back into a productive life. And I think this is what this type of transplant is all about. It's restoring a patient to normalcy."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.