
Life and Limb
Prosthetics research is being fueled by new thinking, new materials, and new demands from those who rely on them
From the Archives: This article appeared in the Spring 2018 issue of Harvard Medicine magazine.
You won’t see World War II veterans with these injuries. You won’t really see Korea or Vietnam veterans with these injuries,” says Gregory Galeazzi. “Plenty of them got them; they just didn’t survive them. Even though medicine has advanced, the majority of people who get these injuries still die on the battlefield.”
“But for a select few,” he adds, “they’re able to piece us back together. They send us out to be socially active and return to the workforce.”
Galeazzi, MD 2021, was a captain in the U.S. Army when he became one of the select few. During a routine patrol in Afghanistan’s Kandahar Province in May 2011, a roadside bomb blew off both his legs and nearly severed his right arm at the shoulder. Without the swift action of his fellow soldiers, who applied tourniquets and rushed their semiconscious platoon leader into a medevac, Galeazzi would have perished.
Instead, after more than fifty surgeries and hundreds of hours of physical therapy, Galeazzi is completing his first year as a medical student at HMS.
The estimated 1,800 U.S. military amputees returning home from recent conflicts in Iraq and Afghanistan have been injured to an extent rarely seen before. Although the technical sophistication of prostheses has grown over the centuries, artificial limbs have yet to attain the capabilities of natural ones. To support work toward that goal, the Department of Veterans Affairs and the Department of Defense fund the lion’s share of prosthetics research in the United States.
While Galeazzi attends class and clinic, scientists and clinicians throughout the HMS community are furthering the national effort by engineering prosthetic arms and legs that behave more like natural ones, pioneering brain-machine interfaces that create more intuitive connections between the nervous system and the prosthesis, and developing surgical techniques that allow for unprecedented prosthesis control and sensory feedback. Their work could benefit not only veterans but the other 98 percent of the two million people in the United States with limb loss due to diabetes, congenital conditions, cancer, and trauma, including accidents.
Perspective Shift
As innovations move from investigational stages to approval by the U.S. Food and Drug Administration, the broadening menu of options for amputees is changing millennia of clinical thinking.
“Historically, amputation has been viewed in the medical realm as a failure,” says Matthew Carty, an HMS associate professor of surgery at Brigham and Women’s Hospital, who is pushing the frontiers of amputation techniques and limb transplantation. “We need to talk about it as a reconstructive procedure and even a form of limb salvage. Physicians and patients need to consider the fact that amputation may be a faster and more effective pathway to better function and better life.”
“The biggest change I’ve seen in recent years is the societal understanding that losing a limb is not the end,” says David Crandell, an HMS assistant professor of physical medicine and rehabilitation at Spaulding Rehabilitation Hospital. Crandell managed the care of fifteen patients who underwent amputations following the 2013 Boston Marathon bombing. “People accept that technology can be part of the solution.”
In Search of the Natural
Because of his battlefield injuries, Galeazzi ended up with two transfemoral—above the knee, through the femur—amputations. Doctors salvaged his arm and fused the elbow. He worked up to wearing prosthetic legs for a few hours each day until a series of health setbacks and the demands of premedical studies derailed his progress. He lost so much bone density in his hips and spine that he fractured two vertebrae in a fall in early 2017. Now he uses a wheelchair, and he’s concerned that his reduced physical activity will affect his overall fitness.
“It took a ridiculous amount of energy to move those prostheses around,” he says. “I was sweating just going from the couch to the bathroom and back.”

Amputees confront dozens of potential health complications, from muscle atrophy and residual-limb infection, to low back pain and osteoarthritis from unnatural movement, to cardiovascular and metabolic disease from inactivity. Amputees who lose limbs in sudden events, losses known as traumatic amputations, often struggle with additional serious injuries, such as hearing damage, burns, and traumatic brain injury.