A team approach in the operating room is also important, Sheehan said, to ensure the future success of adapting to a prosthesis. Sheehan likes to have a vascular surgeon, an orthopedic surgeon, a plastic surgeon and sometimes a peripheral nerve specialist collaborating during surgery.
"What they do at that point is going to affect the person all the way down the line," he said. "The skin need to be closed in a certain way so we’re able to work with a person who will need to have a prosthesis. If someone has an exposed nerve or a bone not appropriate handled, they'll end up with problems with their prosthesis later."
After the risk of blood loss is over, the next level of risk is infection, Esquenazi said. The heat from the explosive device may have sterilized the pieces of metal that wedged into limbs, but infection is still possible.
Some patients whose limbs were damaged at the marathon but still intact may face future choices about amputations, Esquenazi said. Soldiers with similar blast injuries sometimes choose amputation over multiple surgeries, he said. Amputation can allow someone to start rehab faster and get back to their new normal life.
After surgery, it can take a while for the body to realize a limb is gone.
"In some instances I have had patients who would try to get out of bed when they awake in the middle of the night not realizing their leg is not there anymore," Equenazi said. "The body is resilient and has memory, but eventually it adjusts."