Friday , January 15 2021

Tetraplegics can move your hands again – a luminaire in Nottwil makes it possible

Thanks to new methods, quadriplegics can move their arms and hands again. These surgeries can only be performed by about 30 surgeons around the world. Jan Fridén of the Nottwil Swiss Paraplegic Center is one of them.

Niels Jost

Hand surgery Jan Fridén has already performed surgery in more than 1200 tetraplégicos, so that they can move their hands again. (Photo: Nadia Schärli (Nottwil, October 30, 2018))

Hand surgery Jan Fridén has already performed surgery in more than 1200 tetraplégicos, so that they can move their hands again. (Photo: Nadia Schärli (Nottwil, October 30, 2018))

Jan Fridén is a wanted man. You do not really have time for an interview. As a result, the appointment is available several weeks before. Therefore, it is surprising that the surgeon appears at our meeting at the Swiss Paraplegic Center (SPZ) in Nottwil: T-shirt, informal trousers and tweezers. Fridén looks charismatic, relaxed, but her eyes are focused. I've just been on the operating table, explains Swedish, but his colleagues from the hands and tetrahedral surgery department continue now.

Although Friden speaks a good German and even a little German Swiss, we speak in English. So I could explain better how it is possible that quadriplegics can move their arms and hands again restricted and why one in five decided against such OP.

Jan Fridén, is considered a luminar in tetrahedral surgery, performed about 1200 manual reconstructions in patients with spinal cord injuries. Only about 30 surgeons around the world can do it, although the methodology has been known since the 1970s.

At that time, the method received too much attention. Only about ten years ago, the nervous transfer technology was resumed and has since evolved constantly. My technique is unique because we can do it with just one operation, so that the patient can open and close their fingers without using the original muscles or tendons. This is done by placing your muscles or nerves in a different position.

What patients do you and your team of six people care for in SPZ?

People with spinal cord injuries, but also from the brain come to us. People who do not have or have a clean arm or manual functions. Whether it's an accident, illness or infection, we can recover all or part of the functions of the hand. There are three surgical methods: We changed the muscles, tendons or nerves and reassembled them.

"If you can move your hands again, you will recover tremendous quality of life."

How does it work?

The method we use depends on the height of the spinal cord. If paralysis is relatively deep, for example, a muscle transfer is called into question. We change an intact muscle from the upper or lower arm to a place where you can perform central functions, such as bending your fingers or closing and opening your fist.

That is, the muscles of tetraplexisms are paralyzed, but are still intact?

The muscles are fully functional. They just need a boost. To do this, we cut off an intact nerve and insert it into the non-functional nerve. The nerve grows again – up to one millimeter per day! Make sure that the growing nerve finds the target muscle, which in turn allows manually mentioned functions.

The interview is interrupted. Fridén furniture rings. "This is the operating room, I must come quickly," he says. Some tips later, he turned to focus on the conversation, but says: "In 30 minutes, I have to go back to the operating room, is it possible?"

How long does an operation last?

Five to six hours. But that is not enough.

What does that mean?

After this complicated operation, patients should remain in SPZ for up to three months and then spend several months in the outpatient area. Say: away from home, back to the clinic. This is the main reason why about one in five refuses an operation.

How long does the rehabilitation process take?

The patient has to reappear all of his arm and hand functions. It takes up to 12 months – and that's a tough job. Because even for simple actions in everyday life, the movements are extremely complex. For example, if you want to raise a glass, first you have to stretch your arm, open your hand, hold the cup with enough pressure and finally turn the glass off again. This requires a lot of time and balance.

"If someone is not willing to face the learning process, the surgery will not help."

Is your method always a success?

If someone is unwilling to face the learning process, the OP will not help. But before each intervention, we carry out tests and a forecast of the functions that the patient will recover. It is not possible to recover 100 percent of the skills, but in any case we will achieve an improvement.

Does that mean

If you can move your hands again, you will recover a tremendous quality of life. Be it when you can hitting someone's hands or embrace them, or even by communication, for example with a cell phone. In addition, patients can move their own wheelchair. Such interventions change the life of the patient and its surroundings. That motivates me to go to work every day.

Does the insurance pays for the procedure?

Yes, but we need to tell the insurers exactly what skills the patient is going to recover. But only when someone can get dressed again, this relieves the health system in the long run.

Recently, the media reported that a paraplegic may walk again thanks to a therapy with ETH. Would that be possible with your method?

No The legs carry all the weight of the body. Currently, we can not revive this great muscle mass by means of muscular or nervous transmission techniques.

However, modern medicine seems to have no limits. How far should it pass? He also plays ethically in your work
Principles a role?

Sure Instead, I wonder how I can give as many people as possible access to these modern methods. These are only available in about 15 countries around the world. It would be good if it were much more.

He has been in SPZ since 2011, previously headed the Hand Surgery Center of Tetra at the University Hospital of Göteborg, his home. Why change to Nottwil?

The Competency Center with the Man Surgery Department at Nottwil is unique in Europe. Our team consists not only of surgeons, but also by physiotherapists and occupational therapists, researcher and doctor.

After 60 minutes the interview ended. Fridén only 5 minutes for the photo shoot. "So I have to go to the operating room."

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