Army veteran Brandon Korona pulls up his pant leg, rearranges a protective sleeve, and twists off the plastic socket on top of his prosthetic left leg. It comes off with a suction cup-like pop.
"There we go," says Korona.
As Korona gets comfortable in a physical therapy room at Brigham and Women’s Faulkner Hospital, Dr. Matthew Carty pulls up a chair and examines the end of the residual limb, poking and prodding the stump that ends about four inches below Korona’s knee joint.
"It’s looking good, Brandon," says Dr. Carty, who's director of the Lower Extremity Transplant Program at the Brigham. "This little wrinkled area, we’re going to fix that up. But things look really good. ... [T]hings are nice and soft."
From a few feet away, Korona’s stump appears like any other. But look closely and you see muscles and tendons moving beneath the skin.
"It looks like a bag of snakes," Carty says. "It’s alive."
And that really excites Carty. Because what looks like "a bag of snakes" is actually Korona controlling his leg muscles as if his foot and ankle were still attached. The ability to do that creates new possibilities for Korona and other amputees like him.
"I have days that I forget that I’m an amputee," Korona says. "Even noticeably now, where my phantom foot is right where it should be. I can feel my heel. I can feel my toes and as I move the limb. I can feel that moving through space."
During surgery, Dr. Carty built tendon pulleys near the bottom of the residual limb, on top of what remained of Korona's tibia bone. The pulleys help preserve the normal signaling between his muscles and his brain, allowing his leg muscles to function the way they naturally would.
When paired with a next-generation bionic limb, Korona says, “It feels real.”
But if not for the Boston Marathon bombing, a Ewing amputation wouldn’t have been an option for Korona. To understand why, you have to go back to April 15, 2013.
'Do Something Out Of Our Gratitude'
Standing in front of Marathon Sports on Boylston Street, Audrey Epstein Reny was cheering runners toward the finish. She was with her daughter, Gillian, and several other family members when the bombs went off.
“It’s something no civilian should ever see. No mom should ever see,” Audrey says. “Various member of our family all sustained minor injuries. But my daughter Gillian was severely injured.”
The bombing left Gillian’s lower right leg mangled. For days, surgeons at Brigham and Women’s Hospital worked furiously to save it. And they did.
The weeks that followed were mostly a blur for Audrey and Gillian. But between all the operations, medical tests and physical therapy, they would find time to watch "Friends" and talk. That time together helped them process what was going on and reflect on the care Gillian received in the critical hours and days after the bombing.
"We would also just marvel and talk about the amazing doctors and nurses who were involved with her care," says Audrey. "And so the seeds of thinking that we wanted to do something out of our gratitude had been planted."
And the Gillian Reny Stepping Strong Center for Trauma Innovation was born. The center’s mission: Change how people think about trauma treatment, amputation and limb restoration. The goal for patients: better quality of life after traumatic injuries.
Gillian is humbled that the center bears her name. But she also knows how much her treatment influenced Stepping Strong’s mission.
“When we went to actually start something," she says, "we reflected back and said, ‘OK, what was most important to Gillian? What was most important to us as a family? Which doctors, which different areas were so important to us and meaningful to us?' "
Research takes place in laboratories at the Brigham amid whirring centrifuges and clinking beakers. Current research projects involve finding better ways to control life-threatening bleeding, creating skin allografts for burn victims with bioactive gel, and developing a portable machine that keeps detached arms and legs alive longer than previously possible.
Of course, there’s also the work Dr. Carty is doing with lower limb amputations. Carty was among the inaugural winners of the 2014 Stepping Strong Innovator Awards, for research that resulted in the Ewing amputation.
"For us [the award] was like the perfect amount [of money] at the perfect time,” says Dr. Carty. “I'd like to think that we would have done it anyway but I think it would have taken longer."
And patients like Korona would prefer not to wait longer for better options.
'Brandon Was A Great Astronaut'
Back in the physical therapy space at Faulkner, doctor and patient sound like old friends as they catch up on their plans for marathon weekend. But Korona and Dr. Carty only met 14 months ago, when another doctor connected them.
Like Gillian Reny, Korona’s lower leg, his left leg, was mangled by an explosion. It happened two months after the Boston Marathon bombing, in Afghanistan. His patrol was hit by an IED. Doctors managed to save his leg, too. But all the surgeries left Korona in constant pain.
“I couldn't walk around the mall without being in pain,” Korona says. “I couldn't stay out too late and stand up too long because my leg would hurt. And it was just, it was a hindrance to my life. It was a hindrance to everything I wanted to do.”
Korona decided it would be best if doctors amputated his lower left leg.
He originally scheduled a traditional amputation. That would have left him with a knotted mass of muscle and tissue at the end of his residual limb. But then he met Carty, who explained how a new procedure would let Korona sense his prosthetic foot and ankle in space.
“When he started to tell me about these pulleys and these muscle bridges that were going to happen in my leg,” says Korona, “it's like, ‘All right, that's kind of sounds cool.’ "
Every time Dr. Carty talks to Ewing amputation candidates, he’s looking for very specific qualities in prospective patients.
“For operations like this we're looking for an astronaut,” says Carty. "We're looking for a kind of perfect blend of intelligence, integrity, honesty -- all the things that we looked for in the people that were going to the moon. Brandon was a great astronaut.”
That’s largely because, as the second Ewing amputee, Korona eagerly embraced the unknown. Korona is now one of eight patients who have undergone the experimental amputation. That number includes rock climber Jim Ewing, who was the first and gave his name to the procedure.
Dr. Carty hopes the current group is the beginning of something much bigger.
“If it only helps like a fraction of a percent of the population, that adds value, for sure, to that fraction,” says Dr. Carty. “But it's way different if you can say this is a better way of doing an amputation, period. I can't say that with confidence yet, but we're getting more and more evidence that suggests that we may be able to say that at some point.”
That aligns perfectly with the goals of Stepping Strong, though Audrey and Gillian Reny are surprised it’s come this far this fast.
“It has exceeded our expectations,” says Audrey. “We have a number of projects that are already impacting people and changing their lives for the better and that happened much more quickly than we would have anticipated.”
This time next year, Korona and the Renys all will be on the marathon course. Gillian will be on the sidelines cheering along the Stepping Strong charity team. And Korona plans to be on the team -- running.
This report comes from the New England News Collaborative, eight public media companies including Rhode Island Public Radio joining together to tell stories of a changing region, with support from the Corporation for Public Broadcasting.