Double hand transplant successful for Dutch woman (46)

New storage technique for donor limbs

Plastic surgeon in training Anne Sophie Kruit will be awarded her doctorate on 24 September for the development of a new storage technique that allows hands to be kept for at least three times longer. Her work also contributed to Maartje’s successful operation.

Bacterial infection

Maartje Bijl (46) can write again and hold the banister. She lost both her hands and feet in 2014 after a bacterial infection. Two years ago, she received two new hands from a donor at Radboudumc. The new hands immediately felt familiar. After a long rehabilitation, Maartje can now live independently again.

Practicing on donated bodies

An operation like Maartje’s is an enormous challenge. The surgeons practiced extensively on the arms of people who donate their bodies to science. They also printed special molds with a 3D printer. That could be prepared in peace.

Phone call

But when the call came about available donor arms, everyone immediately jumped into high gear. Because while a transplant in American hospital series always goes just right thanks to the clever steering work of the paramedic and the sprint of the sporty doctor, things sometimes go wrong in practice.

Melting Ice Cream

‘It is a battle against time,’ says Anne Sophie Kruit, plastic surgeon in training at Radboudumc. ‘Standard procedure is still cooling on melting ice. A piece of skin can be used for transplantation for about 24 hours, but tissues containing muscles are quickly damaged. Muscles need a lot of oxygen and nutrients and therefore damage faster. Tissue with muscle only lasts about 6 hours on ice.’

24-hour operation

That’s very short for a hand transplant. Maartje’s entire operation lasted 24 hours, with one hand taking almost 6 hours and the other as much as 9 hours. And then the donor hands also have travel time from donor to recipient. ‘The longer it takes for an organ to be connected, the smaller the chance of a successful transplant. The damage that occurs in the tissue during storage also increases the chance of rejection. The procedure is very serious for a patient and you want to minimize the chance of rejection.’

Type of ‘energy drink’

Anne Sophie did her PhD research into a new storage technique and shows that muscles and limbs can be kept for at least 18 hours, a huge gain compared to 6 hours on ice. With this technique, doctors connect the donor organs or limbs to a modified mini heart-lung machine immediately after removal. This pumps a special storage liquid through the tissue, a kind of energy drink with oxygen and nutrients. This technique is already the standard for liver and kidney transplantation, but its use on limbs required many adjustments.

Storage liquid

The mini heart-lung machine has not yet been used in Maartje’s operation, but the storage solution has. ‘Two years ago it was still too exciting to combine the first double hand transplant with the new storage technique. But we certainly want to use the machine in the future. We want to move towards a handy device on a trolley, which in terms of size can also be used in the ambulance.’

Good state

Promoter Professor Dietmar Ulrich, head of the Plastic Surgery Department, sees a bright future for the technique of rinsing with the mini heart-lung machine: ‘This technique will change the world of plastic surgery. Previously we had to transplant within 6 hours, but now we have 18 hours. I expect that connecting limbs to the mini heart-lung machine will be the standard technique for transplants worldwide in 10 years’ time.’

More time

Ulrich also sees other applications for the technology: ‘Think, for example, of someone who loses a leg during an accident. Sometimes you cannot put that leg back immediately because the person is not fit enough for a long operation. But it might work a day later. Then it is very nice if that leg remains in good condition. The technique can also be useful if you are moving tissues within a patient, such as in a breast reconstruction from abdominal tissue. In the case of complications such as clot formation, this technique gives more time to resolve this before continuing.’

Double hand transplant successful for Dutch woman (46)
Source link Double hand transplant successful for Dutch woman (46)

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