Docs finish double hand transplant
By Laura Ungar • The Courier-Journal • August 26, 2010
LOUISVILLE – Doctors completed the region’s first double-hand transplant Wednesday, replacing a man’s burned, non-functional hands with two new ones.
The experimental surgery at Jewish Hospital Hand Care Center — the nation’s third double-hand transplant after two in Pittsburgh — took about 17.5 hours. The team from Kleinert Kutz and the University of Louisville included six doctors and 14 fellows, and the team took the unusual step of providing real-time updates by Twitter throughout the surgery.
Dr. Warren Breidenbach of Kleinert Kutz, the lead hand surgeon, said he hopes the patient ultimately recovers 80 percent to 90 percent of function in his hands, returns to all his activities and winds up with “a reasonably good grip strength.”
Post-operative complications can include infections, rejection and blockage of the blood supply.
Doctors wouldn’t give details on the patient or how he was burned, except to say he was a married man who wasn’t injured in the military.
“The real issue is the next 24-48 hours, which is critical,” Breidenbach said.
Breidenbach did say the patient waited three years for the surgery and wanted functioning hands. His daily life was a struggle and he was unable to do simple tasks such as unzip his pants without help, Breidenbach said.
“He said, ‘I’d rather have an amputation than to continue to live this way,’”
Breidenbach said, adding that he’s the first person who came to the transplant program with both of his original hands.
While doctors removed his hands, including the muscle and bone, they kept the nerves, slipping them inside his new, transplanted hands. .
“We were able to salvage tissue from the hand to construct a new hand,” Breidenbach said, adding that they kept the original nerves out to the fingers and rolled new hands on top. “We’re hoping he will get better sensation and (restored nerve function) of the fine muscles in the hand.”
The operation — which officially began at 9:15 p.m. Tuesday after the patient was rolled into the operating room at 7 p.m. — was complex, the doctor said.
There was more scarring than he anticipated, he said, and the patient lost eight units of blood. Doctors rotated in and out of surgery to stay fresh and rested.
All the while, a team member who wasn’t participating in the surgery sent messages by Twitter to update the family and the public.
Breidenbach said one reason they decided to tweet the surgery was to shed light on a procedure that some have found controversial because it involves subjecting patients to harmful, or even deadly, side effects when hands are not necessary for life. He said doctors were committed to continuing their tweets even if they encountered problems.
“It lets people know what’s going on,” he said. “It also holds us accountable.”
Breidenbach said he hadn’t met with the patient’s family to find out what they thought about the continual updates. But he said it provided far more communication than usual from the operating room and might be useful in future operations.
Doctors said the patient will face the same recovery process as the nation’s first five single-hand transplant recipients, whose surgeries also were performed by the Louisville team.
The patient is expected to spend about three months in Louisville recovering and undergoing extensive rehabilitation. He will have both hands in large braces for six weeks, then smaller, more mobile braces for the next six months.
“He’s gonna be very incapacitated, because he’s had both hands removed,” Breidenbach said.
He will need to take anti-rejection drugs for the rest of his life, although doctors said he would get about the same as single-hand recipients — maybe slightly more, Breidenbach said, but certainly not double. These medications can shorten life and cause serious side effects.
Dr. Michael Marvin, an expert in immunosuppression, said the patients may also have more biopsies because two hands are involved.
Doctors said the cost for the procedure over the first two to three months is about $300,000, which is covered as part of the research, with the patient’s insurance helping pay long-term costs.
The transplant is sponsored by the U.S. Department of Defense, Office of Naval Research and the Office of Army Research, and Breidenbach said he would love to someday replace soldiers’ injured hands.
“This technology coincides with a shift in the type of military injuries — face and extremity injuries,” Breidenbach said.
“I’d love to get a soldier” as a patient.