Bomb sur­vivors and medicine step up

5 years on, lessons from Bos­ton vic­tims drive new re­search

Baltimore Sun Sunday - - NEWS - By Philip Marcelo

BOS­TON — In the five years since the Bos­ton Marathon bomb­ing, med­i­cal sci­ence has made promis­ing ad­vances in am­pu­ta­tions and ar­ti­fi­cial limbs, in part be­cause of lessons learned from the vic­tims and re­search dol­lars made avail­able as a re­sult of the attack.

Some of the 17 peo­ple who lost limbs in the April 15, 2013, bomb­ing could, like many other am­putees, ben­e­fit from these de­vel­op­ments, since many are com­ing to a cross­roads in their treat­ment.

A num­ber still strug­gle with pain, and oth­ers may be look­ing to re­place their pros­the­ses, which are ap­proach­ing the end of their use­ful life.

“The col­lec­tive ex­pe­ri­ence in the af­ter­math of the Bos­ton Marathon bomb­ing was a very pos­i­tive one in the med­i­cal com­mu­nity be­cause there was a lot of cross talk be­tween mil­i­tary and civil­ian sur­geons,” said Dr. Benjamin Pot­ter, chief of or­tho­pe­dics at Wal­ter Reed Na­tional Mil­i­tary Med­i­cal Cen­ter in Mary­land, where three sur­vivors were treated and doc­tors are at­tempt­ing some of the cut­ting-edge pro­ce­dures.

“That ex­change and that di­a­logue has been one of the sil­ver lin­ings to have come out of this, in that we’re hope­fully bet­ter ed­u­cated and bet­ter pre­pared for the next one.”

Among other places where re­search is tak­ing place is Bos­ton, where doc­tors are work­ing to com­bine an im­proved am­pu­ta­tion method with more so­phis­ti­cated ar­ti­fi­cial limbs, so that am­putees can one day use their brains to con­trol their pros­the­ses.

The project grew out of lessons learned by Bos­ton doc­tors treat­ing vic­tims of the marathon attack. It was also made pos­si­ble by $200,000 in seed fund­ing from the Gil­lian Reny Step­ping Strong Cen­ter for Trauma In­no­va­tion, a foun­da­tion launched by the fam­ily of a bomb­ing sur­vivor treated at Brigham & Women’s Hos­pi­tal.

“One of the things the bomb­ings crys­tal­lized for me was the need to im­prove am­pu­ta­tions,” said Dr. Matthew Carty, a Brigham & Women’s sur­geon who is de­vel­op­ing the new am­pu­ta­tion tech­nique. “We’ve made amaz­ing ad­vances in pros­thet­ics tech­nol­ogy — re­ally by leaps and bounds — but the way we do am­pu­ta­tions hasn’t kept up to speed with the ca­pa­bil­i­ties that ex­ist now.”

The new lower-leg am­pu­ta­tion tech­nique, which has so far been done on seven peo­ple, pre­serves ten­dons nor­mally sev­ered dur­ing an am­pu­ta­tion. Ten­dons con­nect mus­cles to bone and are nec­es­sary to move one’s limbs.

An­other pro­ce­dure in­volves di­rectly con­nect­ing ar­ti­fi­cial limbs to bones us­ing ti­ta­nium im­plants. These bone-an­chored pros­the­ses have been placed on hun­dreds of pa­tients in other coun­tries, but it wasn’t un­til 2015 that the use of the de­vices was al­lowed in the U.S.

Roughly 50 such op­er­a­tions have been done in this coun­try, in­clud­ing 16 at Wal­ter Reed, ac­cord­ing to Pot­ter.

Brigham & Women’s is also among the U.S. hos­pi­tals seek­ing to do the na­tion’s first suc­cess­ful leg trans­plant. The sur­gi­cal feat has been ac­com­plished in only a few coun­tries, in­clud­ing Spain and Canada.

Bomb­ing sur­vivor Marc Fu­car­ile, who was the last to be re­leased from the hos­pi­tal, said he is in­trigued by the new ad­vances, even if he isn’t in a rush to go un­der the knife again any­time soon.

The 39-year-old from the Bos­ton area lost his right leg in the blast, and his badly maimed left leg causes him un­ceas­ing pain. He fears an­other am­pu­ta­tion might be his only op­tion.

The ar­ti­fi­cial limbs that Fu­car­ile and other sur­vivors were fit­ted with gen­er­ally last five to seven years, so the pa­tients will have to de­cide on the right tech­nol­ogy for the next phase of their lives.

“Some­times the top-ofthe-line Porsche isn’t al­ways prac­ti­cal,” said Paolo Bonato, who over­sees re­search on ar­ti­fi­cial limbs at Spauld­ing Re­ha­bil­i­ta­tion Hos­pi­tal in Bos­ton, where many of the vic­tims were treated. “It might be more sen­si­ble to have a Honda.”

Rarely seen on civil­ians five years ago, the pros­thetic de­vices used by many sur­vivors have mi­cro­pro­ces­sors and sen­sors that au­to­mat­i­cally ad­just the limb and al­low for more nat­u­ral move­ments. They are now more com­mon, but they can cost any­where from about $15,000 to more than $100,000, said Spauld­ing’s Dr. David Cran­dell.

For some am­putees, in­sur­ance of­ten isn’t enough to cover the costs.

The Bos­ton vic­tims, though, re­ceived pay­outs from a com­pen­sa­tion fund, and some have launched fundrais­ing ef­forts or found other ways to cover their costly de­vices.

Fu­car­ile, whose car­bon fiber and ti­ta­nium leg was ini­tially de­vel­oped to help wounded sol­diers re­turn to bat­tle, said his pros­the­sis is no lux­ury.

“If you’re an in­sur­ance com­pany, look at the longterm ef­fect and what you’re sav­ing,” he said. “If I didn’t have my pros­thetic leg, I’d prob­a­bly be over­weight, have heart dis­ease, be closer to di­a­betes and prob­a­bly be more de­pressed.”

CHARLES KRUPA/AP

Bos­ton Marathon bomb­ing sur­vivor Marc Fu­car­ile watches his mi­cro­pro­ces­sor-con­trolled pros­thetic knee, af­ter a step-gate ad­just­ment dur­ing a visit with his pros­thetist.

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