Double arm transplant

  • A surgical team performs a double-arm transplant on Brendan Marrocco at Johns Hopkins Hospital.
Date:5 June 2013 Tags:

In 2009, Brendan Marrocco lost his arms and legs to a roadside bomb in Iraq. In December, doctors at Johns Hopkins Hospital gave Marocco a new pair of arms.. – SF

THE PROCEDURE:

Step 1
Practice: A team of 16 surgeons practised the operation by switching arms between cadavers with arms of dissimilar sizes. “That actually makes us solve harder problems, which is a good thing,” says Jaimie Shores, one of the surgeons on the team. For example, the team trained to trim tendons to the right length so that Marrocco will have a full range of movement.

Step 2
Harvest: Shores and his colleagues amputated the donor arms. They then drained the blood from the arms, soaked them in preservatives, and put them on ice.

Step 3
Operate: The operation was a 13-hour marathon: (A) Surgeons first connected donor and recipient arm bones with screws and plates. (B) The team sutured the tendons and muscles that control the elbows, wrists and fingers. (C) Using a microscope, surgeons lined up Marrocco’s nerves with the donor arms’ nerves. Those beyond the cut will die, leaving behind empty tubules into which Marrocco’s own nerves will grow and migrate into the new arms. (D) “The real challenge is doing all the veins,” Shores says. “You have a lot more veins bringing blood out of the arm than you have arteries bringing blood in.” The transplanted arms turned pink as the blood flow returned.

Step 4
Regrowth and recovery: Marrocco’s nerves should grow into each arm at a rate of 2,5 cm per month; eventually, he’ll regain sensation and up to 80 per cent of function. For the rest of his life, Marrocco may have to take a drug that prevents his immune system from rejecting the donor arms.