Read out Story of Success in Transplantation Technique - The Carinthian police officer Theo Kelz, who had lost both hands in 1994 while investigating a pipe bomb, had two new hands transplanted Tuesday and Wednesday. The operation lasted 17 hours and was the first of its kind in Austria, the second worldwide. Meanwhile, the patient has awakened from deep sleep. According to the doctors at the University Hospital Innsbruck he was in "good general condition". The new hands are well supplied with blood. The biggest difficulty was the search for a suitable donor, according to Innsbruck. Exact details of the donor were not published, it is a man who has taken his hands off after his brain death and in consultation with his wife. He had a similar stature and size and anatomically beautiful hands, said the transplant surgeon Univ. Prof. Raimund Margreiter.

In a marathon operation, an 18-member medical team carried out this unique procedure in Austria, according to the program and without any complications. The policeman also had to transplant a few centimeters of his forearm with both hands in order to ensure the functionality of the hands, according to trauma surgeon Univ. Prof. Sigurd Friedrich Pechlaner, specialist in hand transplants. The challenge would have been to bring the two different skeletons together.

For the time being, the 45-year-old patient was kept in deep sleep to prevent unnecessary hand movements. Now it will depend on the healing process when Theo Kelz can train his new hands in a rehabilitation center. The doctors expect in the next few weeks with the first movements of the hands. But these will not be fully functional. Kelz will do light work and maybe drive a car, according to the experts.

The patient was given strong medication to prevent rejection. The greatest risk of rejection is in the first weeks after surgery. Another year will pass before the patient can make meaningful movements.
So far, there was only one transplant of this size worldwide. An international team of doctors sewed two donor hands to a Frenchman in Lyon. display

Many years of experience with retransplantations were required

These successes have become possible because the Retransplantation technique, in which accident victims sewn their own limbs back, can look back on a long tradition. As early as the 1960s, American surgeons had mastered a masterpiece. In the American city of Boston, doctors had sewn the severed forearm back to a man and for the first time restored the mobility of the hand through the extensive connection of the nerves.
Since then, doctors around the world have replicated feet, legs, hands, arms, ears, noses, and penis. According to the plastic surgeon Robert Hierner of the Hannover Medical School Hannover, about 5, 000 people can lead a fairly normal life in Germany because their limbs have been sewn back to them in lengthy operations.

"Most of our customers played with the circular saw, " says Hierner, one of the few German specialists in the field of implantation surgery. That's why four out of every five patients are male, says Prof. Edgar Biemer, Head of Plastic Surgery at the Munich Hospital Rechts der Isar, with many years of experience. Most accident victims who land on the operating table of the experts have lost one or more fingers. To sew these on again requires the most efforts. "Because of the larger vessels, it is much easier to replant a leg or arm, " emphasizes Biemer. While a forearm, according to Hernerner, can be back in place in four hours, surgeons need much more stamina to replant a finger: 16 hours of surgery are the rule.

In this century, physicians repeatedly attempted to surgically return their amputated limbs to injured people, albeit with moderate success. In 1914, it is reported, an almost completely severed upper arm was sewn. In 1936, an American doctor succeeded in replanting a severed forearm. From the time of the Second World War, the experts know from more than 40 cases to report, but not always on the success of the interventions.
The real era, however, began in the 1960s, after the surgical techniques had become more sophisticated and the material for sewing finer. No month passes today without reports about further operations. For the first time in the summer of 1987, doctors gave back to a soldier his masculinity: the jealous woman had cut off the young man's penis. Two years later, specialists in the state of Arizona repaired a ten-year-old man's head, which was almost completely torn apart from his spine in an accident.

Despite the precise work of the microsurgeons: "After the operation, the patients have to count on restrictions, " emphasizes Biemer, even if they can move a sewn hand after a few weeks and reach for it. In this procedure, the doctors stabilize the bone and connect the tendon and nerve endings to each other. Finally, blood vessels are connected and the skin sutured.

Transplantation of donor limbs is not uncontroversial
The operation in Lyon had made worldwide headlines. A 33-year-old Frenchman had both hands sewn there and the front parts of a donor's forearm. As early as 1998, the same doctors had achieved a world premiere by sewing a donor's hand on a 49-year-old New Zealander.

However, Biemer and Hierner consider such operations to be problematic given the risk to the patient. Because of his life must now take drugs to suppress the immune system to prevent the rejection of the foreign parts of the body. But with this he is almost helplessly exposed to the danger of serious diseases.

"If a seriously ill person gets a donor's heart, this is ethically unequivocally justified, " says Biemer. Otherwise he dies. When transplanting a hand, however, it is important to weigh the dangers and benefits for the patient. In Germany, in any case, the responsible ethics committee of the university would have to give Gr nes Licht . Legally, so far only the donation of organs is regulated, but not of members. Nevertheless, Biemer, who has been driving reproductive medicine in Munich for 25 years, says: "We are prepared."

dpa, APA, Eva Manhardt

science.de

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