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Doctors newspaper online, 08.08.2019
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Today, a lot goes into hand surgery that hardly anyone would have thought possible 50 years ago. A chief physician talks about the proper packaging of severed limbs and artificial tissue.
By Sandra Trauner
© Uli / stock.adobe.com
FRANKFURT / MAIN . Without effort, the patient reaches for a glass of water, passing it from left to right hand and back. "A sensational result," comments his doctor.
What would not be special for other people, comes at the 73-year-old a miracle: In 2013, the farmer was advised in carpentry work with both arms in a band saw. The right forearm was completely severed, the left one just hung so.
Now he is in for another follow-up examination in the Berufsgenossenschaftliche Unfallklinik (BGU) in Frankfurt. The clinic is nearing a round anniversary: On August 18, 1969, 50 years ago, the Department of Hand Surgery was founded – as one of the first in Germany. Today, she heads Chef Michael Sauerbier. His team consists of nine senior physicians and 14 specialist and assistant physicians.
Complex structure
Hand surgeons make it into the media again and again with spectacular operations. Just in Munich in a nearly ten-hour operation a 13-year-old after a bathing accident, a torn forearm again sewn. As early as the 1990s, Sauerbier's predecessor took three toes from a five-year-old who had lost all his fingers and modeled replacement fingers.
Of course, not all cases are so spectacular. But: "In hand surgery and minor injuries are very special," says Sauerbier. Those who slip off the knife when cutting tomatoes often often cut through two tendons, two nerves, two vessels and with a little bit of bad luck also the bone. Hands are not only enormously important to us humans, they are also particularly endangered.
Plastic surgery as driver
40 percent of all occupational accidents are statistics of the professional associations according to hand injuries. In addition to accidents at work, gardening equipment, carpet cutters or motorcyclists are risk factors. Cuts, fractures or bruises are among the most common injuries. An underestimated danger is animal bites in the hand, says Sauerbier. After a cat bite, such wounds should be seen in the hospital immediately.
"Microsurgery was the decisive step that plastic surgery has today where it is," says Sauerbier. You can completely transplant your skin, muscles and nerves "from one place in the body to another" from a nourishing vessel. Frequently, tissue parts are removed from the back or thigh.
Unlike, for example, a breast reconstruction after a tumor, it is "always very time-consuming to restore a hand". In cases of good outcome, such as the farmer's accident, limbs are neatly severed and can be sutured again. Of course that is simply not easy. Every tiny nerve, every millimeter-thin vein must be connected, "that requires considerable perfection," says Sauerbier.
If the tissue has to be taken from a different region of the body, eight to ten colleagues are deployed. One team is responsible for the withdrawal region, one for the recipient region. Whether it works, according to the chief physician, is mainly due to one factor: "experience".
Increasingly new methods in use
The methods of sewing or reconstructing the hands have become finer, says Sauerbier, the technical aids such as microscopes better. "For the treatment of the hand, new procedures are increasingly available to us," said Andreas Eisenschenk, President of the Society for Hand Surgery (DGH), in June at the world's largest international congress for hand surgery and hand therapy in Berlin. For example, prior to the operation, 3D models facilitated the accurate planning of an operation.
On the other hand, the time during which a separated part of the body can be preserved has not become longer. In one arm, the so-called ischemia time is around six, in a finger at about ten hours – when he is "well stored," says Sauerbier. Cooled, but not directly in the ice, advises the expert, in a sterile container, which is cooled with ice.
"I've been lucky 100 times," says the farmer six years after his accident. His son found the unconscious father, the tenant became a first responder, victims and expertly packed arm were flown to Frankfurt, in a ten-hour operation, the severed right and half-torn left arm were sewn again. "Without you, I would have lost my arm," says the 73-year-old today to sour beer, "if not my life."
And the development continues. That people who have lost a hand, the hand of a dead person is transplanted, is no longer an isolated case. At the BGU there was no such intervention yet. Another approach that could revolutionize hand surgery in the future is to breed replacement tissues. Sauerbier places great hope in this development, even though he says today: "We are not that far yet." (dpa)
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