Veteran Brendan M. Marrocco received to new donated arms he is now retired infantryman wheels himself into a news conference, followed by surgeons, after 13 hour operation (from left, W.P. Andrew Lee, M.D., Jamie Shores M.D., Patrick L.
Brendan Marrocco relaxes on duty in Iraq before his devastating accident in April 2009 due to extensive injuries he lost all four limbs. Marrocco expects to spend three to four months at Hopkins, then return to a military hospital to continue physical therapy, his father said. Before the operation, he had been fitted with prosthetic legs and had learned to walk on his own. He had been living with his older brother in a specially equipped home on New York's Staten Island that had been built with the help of several charities. Shortly after moving in, he said it was 'a relief to not have to rely on other people so much.'The home was heavily damaged by Super storm Sandy last fall. Despite being in a lot of pain for some time after the operation, Marrocco showed a sense of humor, his father said.
He had a hoarse voice from the tube that was in his throat during the long surgery and decided he sounded like Al Pacino. He soon started doing movie lines. 'He was making the nurses laugh,' Alex Marrocco said. Brendan Marroccolost his four limbs in a 2009 roadside bomb attack in Iraq. With him are Johns Hopkins School of Medicine's Department of Plastic and Reconstructive Surgery Director W.P. Andrew Lee (right) and Johns Hopkins Medicine's Vascularized Composite Allotrans plantation Program Scientific Director Gerald Brandacher (left) This graphic shows an illustration of one of Brendan Marrocco's arm transplants.
A surgical team led by Johns Hopkins physicians performed the institution's first bilateral arm transplant on 18 December 2012 Intense Concentration: This photograph from December 18th shows the surgical team at Johns Hopkins Hospital during their 13-hour operation on Brendan Marrocco All five recipients have done well, and four have been able to take just one anti-rejection drug instead of combination treatments most transplant patients receive. Minimizing anti-rejection drugs is important because they have side effects and raise the risk of cancer over the long term.
Those risks have limited the willingness of surgeons and patients to do more hand, arm and even face transplants. Lee has received funding for his work from AFIRM, the Armed Forces Institute of Regenerative Medicine, a cooperative research network of top hospitals and universities around the country that the government formed about five years ago. With government money, he and several other plastic surgeons around the country are preparing to do more face transplants, possibly using the new immune-suppression approach.The team at Johns Hopkins physicians perform the Johns Hopkins Hospital's first bilateral arm transplant on 26-year-old patient Brendan M. Marrocco
'I just want to get the most out of these arms, and just as goals come up, knock them down and take it absolutely as far as I can,' Brendan Marrocco said Tuesday. The 26-year-old New Yorker spoke at a news conference at Johns Hopkins Hospital, where he was joined by surgeons who performed the arduous and complex 13-hour operation. U.S. Army Sgt. Brendan Marrocco of Staten Island, New York, who lost his four limbs in a 2009 roadside bomb attack in Iraq, speaks during a news conference after receiving double arm transplants, performed at John Hopkins Hospital. After he was wounded, Marrocco said, he felt fine using prosthetic legs, but he hated not having arms.
'You talk with your hands, you do everything with your hands, basically, and when you don't have that, you're kind of lost for a while,' he said. Marrocco said his chief desire is to drive the black Dodge Charger that's been sitting in his garage for three years.'I used to love to drive,' he said. 'I'm really looking forward to just getting back to that, and just becoming an athlete again.' Basile M.D. and Gerald Brandacher M.D.) on Tuesday, January 29th 2013 at Johns Hopkins hospital in Baltimore Marrocco also received bone marrow from the same donor to minimize the medicine needed to prevent rejection. He said he didn't know much about the donor but 'I'm humbled by their gift.
'The 13-hour operation on December 18th was led by Dr. W.P. Andrew Lee, plastic surgery chief at Hopkins.- Marrocco was being released from the hospital Tuesday but will receive intensive therapy for two years at Hopkins and then at Walter Reed National Military Medical Center in Bethesda. After a major surgery, human nerves regenerate at a rate of an inch per month, Lee said. 'The progress will be slow, but the outcome will be rewarding,' he added. The infantryman also received bone marrow from the same dead donor who supplied his new arms. That novel approach is aimed at helping his body accept the new limbs with minimal medication to prevent rejection. The military sponsors operations like these to help wounded troops. About 300 have lost arms or hands in Iraq or Afghanistan.
Retired Infantryman Brendan M. Marrocco sits with his two transplanted arms resting in his lap during the news conference.Although he doesn't expect to excel at soccer, his favorite sport, Marrocco said he'd like to swim and compete in a marathon using a hand-cycle. Marrocco joked that military service members sometimes regard themselves as poorly paid professional athletes.His good humor and optimism are among the qualities doctors cited as signs he will recover much of his arm and hand use in two to three years.
'He's a young man with a tremendous amount of hope, and he's stubborn - stubborn in a good way,' said Dr. Jaimie Shores, the hospital's clinical director of hand transplantation. 'I think the sky's the limit.' Shores said Marrocco has already been trying to use his hands, although he lacks feeling in the fingers, and he's eager to do more as the slow-growing nerves and muscles mend. 'I suspect that he will be using his hands for just about everything as we let him start trying to do more and more.
Right now, we're the ones really kind of holding him back at this point,' Shores said. The procedure was only the seventh double-hand or double-arm transplant ever done in the United States. The infantryman was injured by a roadside bomb in 2009. He is the first soldier to survive losing all four limbs in the Iraq War. Experimental: The surgical team led by Johns Hopkins physicians performed the institutions first bilateral arm transplant, together with an innovative treatment to prevent rejection of the new limbs. Unlike a life-saving heart or liver transplant, limb transplants are aimed at improving quality of life, not extending it. Quality of life is a key concern for people missing arms and hands — prosthetics for those limbs are not as advanced as those for feet and legs. 'He was the first quad amputee to survive,' and there have been four others since then, Alex Marrocco said.The Marroccos want to thank the donor's family for 'making a selfless decision ... making a difference in Brendan's life,' the father said.
Brendan Marrocco has been in public many times. During a July 4 visit last year to the Sept. 11 Memorial with other disabled soldiers, he said he had no regrets about his military service. I wouldn't change it in any way. ... I feel great. I'm still the same person,' he said. 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.
Marrocco's 'was the most complicated one' so far, Lee said in an interview Monday. It will take more than a year to know how fully Marrocco will be able to use the new arms. 'The maximum speed is an inch a month for nerve regeneration,' he explained. 'We're easily looking at a couple years' until the full extent of recovery is known. While at Pittsburgh, Lee pioneered the immune-suppression approach used for Marrocco. The surgeon led hand-transplant operations on five patients, giving them marrow from their donors in addition to the new limbs. 
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