Brendan Marrocco, a veteran who lost all four limbs during the Iraq War in 2009, successfully underwent a double-arm transplant in December, Johns Hopkins Hospital announced Monday.

Marrocco had been wearing prosthetic limbs before undergoing the surgery at Johns Hopkins on Dec. 18, reports The Associated Press. The double-arm surgery is just the seventh double-arm or double-hand transplant in America and the first such operation at Johns Hopkins, in Baltimore.

The 26-year-old soldier received the arms and bone marrow, to reduce the chance of his body rejecting the limbs, from a single deceased donor, notes AP. Marrocco has been active on Twitter and has said he still needs anti-rejection medicine for his transplanted limbs.

The double-arm transplant will let the vet live a much more normal life than if he had to rely on prosthetics. AP notes that hand and arm prosthetics are not as advanced as foot and leg prostheses, movement and other more complicated hand motions being the most obvious factors.

According to Alex Marocco, Brendan’s father, “He was the first quad amputee to survive,” reports AP.

The double-arm transplant was performed by Dr. W.P. Andrew Lee, chair of the Department of Plastic and Reconstructive Surgery at Johns Hopkins, and lasted for 13 hours, reports AP. Lee is an expert in double-limb transplants, out of the seven total surgeries, he has led four of them, including Marrocco’s, notes AP.

While Lee expects the veteran will regain full use of his limbs, the process will take several years. Lee stated that nerve regeneration, which leads to the ability to use and control the limbs, occurs at a pace of an inch per month, at best. Lee also helped introduce the use of bone marrow to limit the amount of anti-rejection medication needed after transplant surgery.

The Armed Forces Institute of Regenerative Medicine provided funding for the surgery, and Lee plans more face and arm transplant thanks in part to the government funding, AP reports. Marrocco has been recovering at Johns Hopkins since the surgery and will spend another three or four months at the hospital before transferring to a military hospital, where he will take part in physical therapy, reports AP.

Despite the difficult surgery, Marrocco seems in good spirits and has been an active presence on Twitter, tweeting, sharing photos and chatting daily. Marrocco has given updates and responds to others who have tweeted at him. On Jan. 18, the soldier discussed his progress saying, “Ohh yeah today has been one month since my surgery and they already move a little.” NASCAR drivers Joey Logano and Brad Keselowski paid the young soldier a visit.

John Hopkins has scheduled a press conference for Tuesday where the now double-amputee will discuss the surgery and his recovery.

Medicine Iraq