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April 16, 2018

How the Boston Marathon bombing reshaped research on artificial limbs

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    Artificial limbs and amputations have come a long way in the five years since the Boston Marathon bombing, thanks in part to lessons learned treating the bombing's victims, Philip Marcelo writes for the Associated Press.

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    The marathon bombing prompted a new wave of collaboration between military and civilian surgeons, according to Benjamin Potter, the chief of orthopedics at Walter Reed National Military Medical Center in Maryland. "That exchange and that dialogue has been one of the silver linings to have come out of this," he said.

    Major advances

    Many survivors of the 2013 Boston Marathon bombing have received prosthetic devices that include microprocessors and sensors that automatically adjust to the limb—technologies that were rarely seen on civilian prosthetics five years ago, Marcelo writes.

    The bombing also reinvigorated research into amputation techniques and into prosthetic devices that can be controlled by the brain. Several hospitals and the Massachusetts Institute of Technology (MIT) are currently working on the effort, which is supported by $200,000 in funding from the Gillian Reny Stepping Strong Center for Trauma Innovation, a foundation created by the family of a survivor of the marathon bombing.

    In one element of the project, researchers at Brigham & Women's Hospital are working on a new lower-leg amputation technique that would allow surgeons to preserve the tendons are typically severed during an amputation. Those tendons connect tissue to bone and are vital for movement, Marcelo writes. Ultimately, MIT researchers hope to develop technology that would allow the brain to translate signals through those tendons to move an artificial leg.

    Further, since the bombing, it's become more common to connect artificial limbs to bones using titanium implants. According to Marcelo, such devices weren't even allowed in the United States until 2015. To date, about 50 operations using the titanium implants have taken place in the United States, including 16 at Walter Reed.

    Researchers at Brigham & Women's also are working to complete the first successful leg transplant in the United States. The procedure has been successfully completed in only a few countries to date, Marcelo writes.

    Matthew Carty, a surgeon at Brigham & Women's who is developing a new amputation technique, said, "One of the things the bombings crystallized for me was the need to improve amputations." He added, "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."

    A heavy cost

    These procedures aren't without significant cost, however. Marcelo writes that the artificial limbs most Boston Marathon bombing victims received are expected last about five to seven years, and according to David Crandell, a doctor at Spaulding Rehabilitation Hospital in Boston, they cost anywhere from $15,000 to over $100,000.

    Insurance doesn't always cover the costs associated with prosthetics. The victims of the marathon bombing have received money from a compensation fund, but others who use prosthetics often must fundraise or use other means to cover the cost of their procedures.

    Marc Fucarile, a survivor of the bombing who lost his right leg in the blast, said insurers incorrectly view prosthetics as a luxury.

    "If you're an insurance company, look at the long-term 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" (Marcelo, Associated Press, 4/11).

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