In 2007, Cpl. Joshua Maloney’s life was changed forever when he lost his right hand. Maloney, a self-proclaimed “lifer” in the Corps, had to cut his time as a Marine short and was medically separated. Two years later, he was given the rare opportunity to change his life yet again — this time for the better.
While some advancements in modern medicine over the last decade have saved the lives of multiple service members, more recent developments are going a step further by improving the quality of life for these injured service members. One such innovative technique is called reconstructive transplantation, which includes hand-transplantation. Only a small number of Americans have received this elaborate, new procedure and in 2009, Maloney became one of them.
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The events leading to Maloney’s need for a transplant procedure is not what most would expect. Although Maloney, a combat engineer, has served a combat tour to Iraq, he didn’t sustain his injury during the deployment. It was while Maloney was serving as a member of the Combat Instructor Company for new lieutenants at The Basic School in Quantico, Va., in 2007 that the injury occurred.
Maloney and the instructors were teaching lieutenants about improvised explosive device procedures and how to handle detonations. Maloney was preparing explosives for a simulation when something went wrong.
“While I was clearing up the debris from the hole to put the TNT in, a Marine on the other end plugged the wires into the box,” Maloney said. “The box was faulty and I went up like a Christmas tree.”
When Maloney hit the ground, he knew something was terribly wrong. Three days later when he woke up in Walter Reed National Military Medical Center in Bethesda, Md., doctors had amputated his hand just above the wrist because of the extent of his injuries.
Initially, Maloney was of the mindset that he would be going right back to work alongside his Marines. But he was wrong. Instead he began the painful recovery process, motivated by the constant presence of his fellow Marines.
“I realized I had two choices,” Maloney said. “I could either be angry at the world and waste all that energy and hate life, or deal with it and move on and find something else.”
Maloney decided he didn’t want to waste his energy being angry so he had no choice but to adapt to his new “normal.” Four days after his amputation, Maloney taught himself to write with his left hand, just one of the ways he was determined to overcome his injury.
Eventually, Maloney returned home to Pittsburgh before being medically retired. Beyond adapting to the physical changes in his life, Maloney now had to tackle what his future would hold outside the Corps.
“I never really had a plan for getting out of the Marine Corps,” Maloney said. “I was going to stay until I died or they kicked me out.”
Maloney worked odd jobs, went to college and tried to find his niche in the world before a rare opportunity presented itself at the University of Pittsburgh Medical Center. UPMC was looking for an eligible candidate to be the first to undergo a hand transplantation at the facility.
After an extensive medical and psychological screening process, Maloney, was approved.
During the screening process, Maloney was told by doctors and specialists he would probably only get about 65 percent use of his hand in the years following the procedure, but Maloney was determined to defy the odds.
“I used to snicker and laugh and say, ‘I’ll get it back and make it perfect,’” Maloney said. “I was a little unrealistic about it. I thought I’d do everything I had to do and within a year’s time it would be working great and I could get back in the military.”
The procedure, which took place March 14, 2009, took roughly 10 hours and involved attaching bone, tendons and veins between Maloney’s arm and the transplanted hand.
In order for the transplant to be a success, a patient must stick to a rigorous anti-rejection medication regimen, be committed to rehabilitation and assume a new lifestyle, said Dr. Joseph Losee, Professor of Surgery and vice chair of the Department of Plastic Surgery at UPMC.
“Assuming a new lifestyle is very difficult,” Losee said. “It’s a dynamic process because life changes. I mean, you get married, you get divorced, you have kids, parents die, you have a new job and despite all of those dynamic processes that are normal to life for everybody, you must have as your priority being a transplant patient.”
It’s this lifestyle change that most patients, like Maloney, find the most difficult, Losee said.
In order to gain the most use of the transplanted hand, Maloney had to go through intensive therapy, Monday through Friday, eight hours a day.
“It started to become taxing because I had other things I wanted to do,” Maloney said. “I didn’t want to spend two, three years attached to a hospital. They make me nervous. I wanted to be up and moving.”
Maloney’s progress in the first year of therapy was incredible. He exceeded expectations by gaining about 80 percent normal function, sensation and motion of the transplanted hand. Things that were once impossible, like tying his shoes and using chopsticks, suddenly became possible.
Maloney was encouraged by his progress and the temptation to slack off on his medications and therapy became too much for him. He was eager to get on with his life again, but it was too soon.
Maloney struggled with rejection issues and spent long staunches in the hospital.
After months of struggling, Maloney had to make a decision. If he wanted to keep the transplant, he had to commit the next several years to driving 50 miles for regular appointments with the team at UPMC. He would also have to rethink his career choice as an automotive technician since it posed a high risk of injury to his transplanted hand and fingers.
After careful consideration and consultation with his doctors, Maloney decided in January to have the transplant removed March 14, 2013.
“I wasn’t excited about the decision,” Maloney said. “It felt like I was quitting. It took me a few months and a lot of thinking before I finally reached the decision that we had given it everything we could. It’s not working out.”
Although most wouldn’t consider the procedure a success, both Maloney and the doctors remain positive about transplantation and the possibilities ahead.
“I would definitely recommend it to somebody else if they are willing to give it a shot,” Maloney said. “I don’t have any hard feelings or animosity toward anything as far as this goes. I think it was a great experiment and a great program.”
The medical personnel at UPMC are continuing to make progress in the realm of transplantation. They have now transplanted eight limbs on five patients with more to come. They are continuing their research on the complex cases that combat injuries present so they can continue improving the lives of our nation’s wounded warriors.
Meanwhile, Maloney has adopted the same attitude as when he first received his injury. Although the transplant didn’t turn out like he had hoped, he isn’t going to waste energy being upset. He is moving on to embrace something new.