Second hands

German surgeons performed a unique transplantation

The operation to transplant two donor hands at once, which until recently was considered one of the most difficult and practically impossible, was successfully carried out at the Munich university hospital Klinikum rechts der Isar. This is not the first attempt by doctors to restore a patient’s upper limbs, but, as doctors have already stated, it is one of the most successful. Thanks to a new generation of immunosuppressive drugs used by German surgeons, the likelihood of tissue rejection in their patient - a 54-year-old farmer from Bavaria - is much lower than in previous recipients.

A German agricultural worker lost his arms after carelessly using a threshing machine six years ago. Over the years, the blood vessels and capillaries that carried blood to the limbs had significantly atrophied and narrowed due to inactivity. Finding them and connecting them with the vessels of donor arms was one of the most difficult tasks for surgeons. It is worth noting that Bavarian doctors prepared for the transplant for more than five years, properly preparing their patient: his overall health condition was constantly monitored. But only now have they found a suitable donor. He turned out to be a 19-year-old resident of Augsburg who died in a car accident on Friday. Such a significant difference in the age of the donor and recipient, as doctors note, is another risk.

But the main difficulty of limb transplantation is that, unlike internal organs, the limbs are covered with skin. “The skin is the body's biggest immune barrier, so the rejection forces we encounter in hand transplants are much stronger than in traditional transplants,” says Professor Edgar Beamer, who led the team of surgeons involved in the operation. In total, 30 specialists worked under his leadership, divided into five groups: two groups were engaged in simultaneous transplantation of the upper limbs, another was engaged in the removal of donor vessels, the transplantation of which should ensure blood supply to the donor arms. The surgeon said that first the bones had to be fastened with special reinforcement and screws, and only then the vessels and tissues were sutured under microscopes. “Finally, we have successfully connected the critical nerve endings of the donor arms to the patient’s shoulders. But this, of course, is only the skeleton. From it should grow thinner nerve tissue, which penetrates all the other soft tissues of the hands. But this process is very slow. Therefore, it may take about two years before the patient feels his new fingers,” Mr. Beamer explained to reporters.

The most important aspect of this transplantation, of course, is the psychological factor. Therefore, the farmer was examined by psychologists and psychiatrists for a long time. “Not everyone can survive this, but our patient is made of the right stuff,” noted the attending physician. As the doctors said, he himself came to them with a request to find him a donor. “He found me after I appeared on a television program about hand transplants for a bomb victim,” says Edgar Beamer. Apparently, the German patient’s psyche is really all right. The next day after the grueling operation, he was already smiling at his wife. And in five weeks they are going to discharge him. “Of course, he won’t be able to play the piano, but my patient’s life will be much better,” Professor Beamer is confident.

Galina PAPERNAYA