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Double-arm transplant helps Soldier who lost limbs in Iraq

By C. Todd Lopez

WASHINGTON (Feb. 01, 2013) -- Former infantryman Brendan Marrocco has two arms again, real ones that he can already move, thanks to a double-arm transplant surgery performed at Johns Hopkins.

"It's given me a lot of hope for the future," said Marrocco, about the successful completion of the surgery. "I feel like I've gotten a second chance to start over after I got hurt. So I'm just excited for the future, and where I could go with it."

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Morocco lost both arms and both legs to an explosively formed penetrator in Iraq in 2009. He was injured while conducting raids and doing presence patrols. He was a private first class at the time, serving as a "Wolfhound" with the 25th Infantry Division, 2nd Battalion, 27th Infantry Regiment. He was medically retired as a sergeant in May 2012.

During a press conference, Jan. 29, at Johns Hopkins in Baltimore, Md., Marrocco and several members of the 16-person team of plastic, orthopedic, and micro-vascular surgeons who performed the procedure discussed the surgery. This is the first time a double-arm transplant has been performed at Johns Hopkins. The surgery took 13 hours, and was sponsored by the Armed Services Institute of Regenerative Medicine.

"The surgical team had rehearsed the procedure on cadaver arms four times in the last 18 months and the transplant was executed according to our design," said Dr. W.P. Andrew Lee, director of the Department of Plastic and Reconstructive Surgery at Johns Hopkins. The surgery, Lee said, was the most expensive and complicated arm transplant ever performed.

During the surgery, Dec. 18, the team replaced Marrocco's right arm, above the elbow, with a donor arm, Lee said. On the left side, where Marrocco still had an elbow, the team replaced his entire forearm over his own remaining tissue. Donor bone, muscle, blood vessels, nerves and skin had to be connected to Marrocco's own tissue. Marrocco was also given transplanted bone marrow from the donor as a way to help keep his body from rejecting the donor arms using fewer anti-rejection drugs.

"He will take only one anti-rejection medication instead of the usual triple-drug cocktail," Lee said.

During the press conference, Marrocco didn't sit still. Like anyone, he inadvertently moved his left arm to scratch his head, or shift it around, something he couldn't do just six weeks ago.

"I just kind of do it," Marrocco said of his own unconscious, but normal arm movement. "I don't realize it anymore. I've been using the arms, the hands, to text and use my computer and scratch my face and do my hair. It's just they've truly become a part of my everyday life in the last six weeks. That's the way we want it."

Right now, Marrocco is involved in "intensive hand therapy," Lee said, which includes range of motion with his new fingers, wrists and elbow. The therapy will help him to learn to use his hands and arms again.

"Right now it's not too intense for me because I can't really feel what she's doing," said Marrocco, of his current work with a physical therapist. He currently can't feel his arms, because the nerves are still developing. "Down the road I'm sure it'll get a lot worse -- a lot more intensive, and a lot more work."

Lee said it will take a considerable amount of time for the nerves in Marrocco's arms to regenerate. The nerves, he said, regenerate at about one inch each month, and that there are "many, many inches" of nerves. "The process will be slow, but the outcome will be rewarding," he said.

Marrocco is no longer in the Army, and hasn't yet made plans for his future. But he does have plans for what he'll do with his new arms when he regains enough control.

"Driving; I used to love to drive. And it was a lot of fun for me. So I am really looking forward to getting back to that," he said.

There's a black Dodge Charger SRT8 with black rims waiting for him back home. "I've had it sitting in the garage for like the last three years," he said.

Marrocco also said he wants to get back to being an athlete, like he was before his injury, when he was a Soldier and when he enjoyed playing soccer.

"One of my goals is to hand cycle and marathon. I'd love to get back to that," he said, adding that he also wants to swim. "I want to get the most out of these arms. And as goals come up, knock them down and absolutely take it as far as I can. I want to get to the point where I can be on my own and get back to enjoying life."

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