Thursday , July 29 2021

Tetraplegics can move their hands again – a luminaire in Nottwil makes this possible



Thanks to new methods, the quadriplegics can move their arms and hands again. Such operations can only be performed by approximately 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 already operated more than 1200 tetraplegia, so they can partially move their hands again. (Photo: Nadia Schärli (Nottwil 30 October 2018))

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

Jan Fridén is a wanted man. There's really no time for an interview. Therefore the appointment was arranged several weeks in advance. It is therefore surprising how the hand surgeon looks at our meeting at the Swiss Paraplegic Center (SPZ) in Nottwil: T-shirt, daily coach pants and finches. Fridén looks charismatic, relaxed but his eyes focus. Swede was working on the operating table, but her colleagues in the hand and tetrahedral surgery department are currently in the process.

Fridén speaks good German and even a little bit of Swiss German, although we speak English. Thus, he could better explain how the quadripple could be able to move his arms and hands again – and a fifth of them decided against such an OP.

Jan Fridén was considered a luminous in tetrahedral surgery and performed approximately 1200 hand reconstruction in patients with spinal cord injuries. Only about 30 surgeons around the world can do this – although the methodology has been known since the 1970s.

At that time, the method received very little attention. Only about ten years ago the nerve transfer technology started again, and it has evolved ever since. My technique is unique because we can only do this with an operation, so that the patient can open and close his fingers without using the original muscles or tendons. This is done by placing the muscles or nerves in a different position.

What kind of patients do you and your six-person team look for in the SPZ?

People with injuries to the brain as well as the spinal cord are coming to us. People who do not have arm and hand functions or have limited functions. We can recover all or part of the functions of the hand, whether due to accident, disease or infection. There are three surgical methods: We change muscles, tendons or nerves and reassemble them.

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

How does it work?

The method we use depends on how damaged the spinal cord is. If the paralysis is relatively deep, for example, a muscle transfer may occur. We move a solid muscle from the upper or lower arm to a place where they can perform central functions such as bending fingers or closing and opening the fist.

So, tetraplegic muscles are paralyzed, but still intact?

Muscles are fully functional. They just need an impulse. For this, we cut a solid nerve and place it on the functioning nerve. The nerve grows again – up to a millimeter per day! We enable the growing nerve to find the target muscle, which allows the hand functions.

Interview stopped. Fridén's cell phone rings. Or This is the operating room, I have to get there fast, “he says. She then focuses on some advice, talking again, but she says: "I have to go back to the operating room in 30 minutes, is that possible?"

How long does an operation take?

Five to six hours. But that's not enough.

What do you mean

After this complex operation, patients should stay in SPZ for up to three months and then spend several months in the ambulatory area. Say: Away from home in the clinic. This is the main reason why a fifth of them refuses an operation.

How long does the rehabilitation process take?

The patient must re-learn all the arm and hand functions. It lasts up to 12 months – it is very difficult. Because even for simple actions in everyday life, movements are extremely complex. For example, if you want to lift a glass, you must first extend your arm, then open your hand, hold the glass at sufficient pressure, and finally close the window again. This requires a lot of timing and balance.

Leş If someone doesn't want to face the learning process, the surgery won't help. “

Is your method always successful?

If someone is not willing to face the learning process, the OP won't help. However, before each intervention, we perform tests and prognosis on which functions the patient will regain. Skills are not likely to improve by 100 percent, but we will achieve an improvement in each case.

This means that?

If you can move your hands again, you will have a tremendous quality of life. When you shake or hug someone's hands, or even communicate with a mobile phone. Patients can also carry their own wheelchairs. Such interventions alter the life of the patient and the environment. This motivates me to go to work every day.

Does the insurance pay for the procedure?

Yes, but we have to tell the insurers exactly what skills the patient will get back. However, if only one can wear it again, this will relieve the health system in the long run.

Recently, media reported that a paraplegic could be able to walk again, thanks to an ETH treatment. Is it possible in your method?

No. The legs carry the whole body weight. At the moment, we cannot revitalize so much muscle mass with muscle or nerve conduction techniques.

However, modern medicine seems to be unlimited. How far should this go? Also play moral in your business
Principles a role?

Of course. On the contrary, I wonder how I can give as many people as possible to such modern methods. They are only available in around 15 countries worldwide. It would be nice if there were a lot more.

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

The Competence Center with the Hand Surgery Department in Nottwil is unique in Europe. Our team consists not only of surgeons, but also physiotherapists and occupational therapists, researchers and doctoral students.

After 60 minutes, the interview is over. We stayed in Fridén, just 5 minutes for a photo session. "Then I have to go to the OR."


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