Friday , January 22 2021

Tetraplegics can move their hands again – an expert at Nottwil makes it possible



Thanks to the new method, paralysis can move their arms and hands again. Such operations can only be performed by around 30 surgeons around the world. Jan Fridén of the Swiss Paraplegic Center in Nottwil is one of them.

Niels Jost

Hand surgeon Jan Fridén has operated on more than 1200 tetraplegics, so they can move their hands again. (Photo: Nadia Schärli (Nottwil 30 October 2018))

Hand surgeon Jan Fridén has operated on more than 1200 tetraplegics, so they can move their hands again. (Photo: Nadia Schärli (Nottwil 30 October 2018))

Jan Fridén is the man sought. He didn't really have time for interviews. Therefore the appointment was arranged several weeks earlier. Therefore it is surprising how hand surgeons appear at our meeting at the Swiss Paraplegic Center (SPZ) in Nottwil: T-shirts, casual trainers and finches. Fridén looked charismatic, relaxed, but his eyes were focused. He had just been on the operating table, the Swedish coach explained, but his colleagues in the hand and tetrahedral surgery department were now continuing the procedure.

Although Fridén speaks good German and even a bit of Swiss German, we speak English. So he can better explain how paralyzed paralyzes can move their hands and hands again – and why one in five decides against the OP like that.

Jan Fridén, you are considered an expert in tetrahedral surgery, have done about 1,200 hand reconstruction in patients with spinal cord injuries. Only about 30 surgeons around the world can do this – even though the method has been known since the 1970s.

At that time, the method received too little attention. Only about ten years ago, nerve transfer technology continued and has since continued to evolve. My technique is unique because we can do it with just one operation, so the patient can open and close his fingers without using the original muscle or tendon. This is done by placing muscles or nerves in different positions.

Which patient did you and your six-person team pay attention to at the SPZ?

People with spinal cord injuries but also the brain comes to us. People who do not have hands or arms are limited. Whether it is due to an accident, illness, or infection, we can restore all or part of the function of the hand. There are three surgical methods: We move the muscles, tendons, or nerves and put them back together.

"If you can move your hand again, you will regain an extraordinary quality of life."

How does it work?

The method we use depends on how high the spinal cord is damaged. If relative paralysis is deep, for example, muscle transfer becomes a question. We shift the whole muscle from the upper arm or lower arm to a place where it can perform central functions, such as bending a finger or closing and opening a fist.

That is, the muscle tetraplegics is paralyzed, but still intact?

Muscle fully functional. They only need one push. For this we cut the intact nerve and put it into a nerve that is not functioning. The nerve grows again – up to millimeters a day! We ensure that the growing nerve finds the target muscle, which in turn allows the function of the hand mentioned.

Interrupted interview. Fridén cellphone ring. "This is the operating room, I have to get there quickly," he said. Some suggestions later, he focused again on the conversation, but said: "In 30 minutes, I have to go back to the operating room, is that possible?"

How long does the operation last?

Five to six hours. But that is not enough.

What do you mean

After this complicated operation, the patient must stay at the 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 one in five refuses surgery.

How long does the rehabilitation process take place?

Patients must relearn all the functions of their hands and arms. It takes up to 12 months – and that's hard work. Because even for simple actions in everyday life, the movements are very complicated. For example, if you want to lift a glass, you must stretch your arms first, then open your hands, hold the glass with enough pressure, and finally turn off the glass again. It requires a lot of time and balance.

"If someone does not want to face the learning process, surgery will not help."

Does your method always work?

If someone does not want to face the learning process, the OP will not help. But before each intervention, we carry out tests and prognoses that function to return the patient. 100 percent skill recovery is almost impossible, but in any case we will achieve improvement.

It means?

If you can move your hands again, you will regain an extraordinary quality of life. Whether it's when you can shake someone's hand or hug them, or even for communication, for example with a cell phone. In addition, patients can move their wheelchairs themselves. Such interventions change the entire life of the patient and his environment. It motivated me to go to work every day.

Does insurance pay for the procedure?

Yes, but we need to tell the insurance company what skills the patient will get. But only when someone can get dressed again will this alleviate the health system in the long run.

Recently, the media reported that paralyzed can walk again thanks to ETH therapy. Is that also possible with your method?

Not. Feet carry all body weight. At present, we cannot revive that much muscle mass by the technique of muscle or nerve transmission.

However, modern medicine seems to have no limits. How far does this have to go? Also play ethically in your work
Principle of role?

Of course. Instead, I wonder how I can give as many people as possible access to such modern methods. It is only available in around 15 countries around the world. It would be better if it was far more.

You have been at SPZ since 2011, before you headed the Tetra-Hand Surgery Center at the University Hospital in Gothenburg, your home. Why change to Nottwil?

The Competency Center with the Department of Hand Surgery at Nottwil is unique in Europe. Our team does not only consist of surgeons, but also physiotherapists and occupational therapists, a researcher and doctoral student.

After 60 minutes, the interview is complete. Fridén only had 5 minutes left for the photo session. "Then I have to go to the operating room."


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