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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne, with Steve Inskeep.

In every war, weapons get more deadly, but medicine advances, too. Now surgeons are improving a relatively new way of saving arms and legs instead of amputating them. But the surgery raises medical and even ethical questions. As part of our Span of War series looking at the impact of the war in Iraq, Joseph Shapiro explains.

JOSEPH SHAPIRO reporting:

It's just moments before Oscar Canon's surgery. The young Marine Corps sergeant lies on a bed with wheels. He's in the surgery prep room, a tiny space divided by a pink curtain. A technician slips a needle through his skin to start an IV for Sergeant Canon.

Sergeant OSCAR CANON (USMC): So I've got a lot of anxiety. Things go wrong, I could lose my leg. Things go right, I could be running within a month and be back to almost like 100 percent. So it's a kind of scared but excited at the same time kind of thing now.

SHAPIRO: Doctors are trying to reconstruct Oscar Canon's shattered left leg. He nearly lost that leg, and his life, last October in Iraq. A rocket-propelled grenade tore off most of his thigh. In the 10 months since, Canon's had 32 operations. Surgeons have transplanted his muscles, stretched his skin, moved his tissue and bone.

Doctors call this limb salvage, or limb reconstruction. It's the attempt to save a leg right after an injury and then rebuild it to try to get it working again. Oscar Canon's limb reconstruction is one of the most extensive doctors anywhere have ever tried.

Dr. AMY WANDEL (Reconstructive Surgeon): This is it.

SHAPIRO: Dr. Amy Wandel walks in.

Dr. WANDEL: Are you ready?

Unidentified Man #1: Yeah.

Sgt. CANON: Yeah.

Dr. WANDEL: I'm ready.

SHAPIRO: Wandel's the chief reconstructive surgeon here at the Naval Medical Center San Diego. Right away, she senses Canon's nervousness.

Dr. WANDEL: You know, this isn't as big as your first operation.

Sgt. CANON: No.

Dr. WANDEL: It's a little bigger than the ones that we've done before, but it's not as big as the...

SHAPIRO: For more than a hundred years, the standard was for doctors to amputate a badly damaged arm or leg. Think of Civil War surgeons at the battlefront wielding cleavers. In the decades since, the field of prosthetics has advanced. Prosthetic legs were once crude stumps of wood. Today, soldiers get legs powered by computer chips and made from materials used on spaceships.

For limb salvage, it's been less than 20 years since surgeons began to master complex ways to save a leg instead of amputating it. It involves closing wounds, fixing fractures, moving muscle, tissue and blood supply. Dr. Wandel says Oscar Canon's injury is more severe than what surgeons normally see.

Dr. WANDEL: So many of the things done for him are kind of cutting-edge, and this procedure is taking a muscle from the inside of his leg and moving it to the front of his leg to increase the strength of the muscles that straighten out his leg.

SHAPIRO: Canon's a good candidate for limb salvage. He's in peak physical condition, he's just 25, he doesn't have to worry about health insurance. The military will pay for everything. Wandel says there's one other thing in Canon's favor.

Dr. WANDEL: He is the most motivated man I have ever met, and he has really grasped on to everything that we've provided him medically and maximized his rehabilitation.

SHAPIRO: Canon started the months and months of surgeries knowing he might wind up with a painful leg he can't use, that it might have to be amputated after all. And it won't be enough for Canon to get a leg that works just OK. He wants to run again so he can stay in the Marine Corps and keep the only job he's ever wanted.

So Canon spends hours in the gym, because he'll have to pass the Marine Corps fitness test again.

Sgt. CANON: You have to be able to run three miles under 28 minutes. You know, now I'm jogging eight blocks, but don't tell Dr. Wandel. So I know that I'll eventually get there because I'll push myself to get there. But this surgery is kind of like the Bionic man, you know. `We can rebuild him better, stronger.' It'll help me out.

SHAPIRO: Last January, when I first met Oscar Canon, he'd just moved back to Camp Pendleton in Southern California after spending months in hospitals back East.

(Soundbite of door being unlocked)

Sgt. CANON: You're going to see it's a friggin' war zone in here.

SHAPIRO: At that time, he walked haltingly, with a cane.

Sgt. CANON: This is all my personal belongings. You know, this is the first time I've opened this thing.

SHAPIRO: In his cluttered garage, there were two pine boxes about the size of a child's coffin, only deeper. They were sent back from Iraq with his belongings.

Sgt. CANON: It's kind of difficult for me to go through this crap. But the one that I wanted to show you is underneath here.

SHAPIRO: Inside was a jumble of clothes, boots, toothbrushes and the jagged remains of the protective gear he was wearing the day his platoon came under an ambush of grenades and gunfire.

(Soundbite of wooden top being moved)

Sgt. CANON: Let's see, right here. This is my pistol holster I had on. You see that red stuff right there, that's all blood. Because I could hear those bullets hitting the truck. I was laying down when I got hit and I just remember I was trying to empty out as many bullets as I could to get those bastards off of me.

SHAPIRO: A rocket went off. Canon looked down and saw a huge divot where his thigh used to be. He could see the white of his bone and his arteries shivering on his leg.

Sgt. CANON: When they got me to the medical unit, I called out to the doctor and he came over, and I reached up and I grabbed him by the neck, by his collar, and I said to him, `Don't cut off my f'ing leg.'

SHAPIRO: Canon arrived at the National Naval Medical Center in Bethesda, Maryland, just days later. Doctors there transferred muscle from a surprising place.

Sgt. CANON: You know, this is basically my stomach over here. My three abs are in here, and yeah, they make up my leg, I guess.

SHAPIRO: His abdominal muscles were moved to cover the artery and keep the blood flowing there. Dr. Annan Kumar(ph) is the plastic surgeon who did the operation that saved Canon's leg. He says there's debate among surgeons about when limb salvage is the best thing to do.

Dr. ANNAN KUMAR (Plastic Surgeon): Is it better for the patient to have an early amputation, which clearly will get you back to walking quicker, or if we provide modern reconstructive technique, can we provide a limb that will at least equal or come pretty close or maybe be better than a artificial limb, but allow the patient to have their own limb?

SHAPIRO: There have been times when Sergeant Canon's had second thoughts, when he's been frustrated by how hard it is to walk or by the persistent pain in his leg. Another Marine he knows had his leg amputated and he's already running and scuba diving and skydiving. So back in the hospital in San Diego, Canon's future depends on Dr. Wandel taking a small skinny muscle from one part of his leg and moving it to another. Canon's wheeled into the operating room for his 33rd surgery. He's about to get anaesthesia.

Sgt. CANON: All right. Here's where the counting--this is where it gets fun. One, two, three, four--you tell me how far I get--five...

Unidentified Man #2: See you later, man.

SHAPIRO: One study compared civilian patients who get legs amputated to those who try to save them. After two years, patients in both groups had legs that worked about equally well, but many in both groups still dealt with pain, and only half went back to their jobs.

(Soundbite of operation)

Dr. WANDEL: Can you go out and get me a couple of scraps for a bandage?

SHAPIRO: Canon's surgery was supposed to last five hours. It took 10. The next day, Dr. Wandel was back in her office before sunrise. The operation was harder than she expected.

Dr. WANDEL: It was very difficult because he was very scarred. His muscle transfer went very well. He was having some pain this morning, but otherwise he's doing pretty well.

SHAPIRO: That surgery was in August. Oscar Canon's since had surgeries 34, 35 and 36. For that last one, to treat an infection in his wound, he was in the hospital again until last week. But Dr. Wandel says Sergeant Canon can jump on his left leg, that he's kicking with power and that he's on track to regain the full use of that leg.

Joseph Shapiro, NPR News.

MONTAGNE: As we have been reporting this morning, President Bush has nominated Harriet Miers to replace Justice Sandra Day O'Connor on the Supreme Court. Harriet Miers is a longtime associate of the president, dating back to Mr. Bush's days as governor of Texas. She now is White House counsel, the president's lawyer. Harriet Miers has never been a judge but she has wide experience as a lawyer, according to the White House. Republicans generally praised the choice. Democrats were more cautious. We will continue to cover this story throughout the day.

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