Finland has reached a significant milestone in medical history with its first-ever hand transplantation, successfully carried out at the Helsinki-Uusimaa Hospital District (HUS) Meilahti Bridge Hospital. The remarkable procedure took place over 17 hours and has raised hopes for enhancing the quality of life for patients who have endured severe amputations.
The operation was performed on a patient who, years ago, lost both hands and legs, as noted by Professor Jorma Ryhänen, head of hand surgery at HUS. "We transplanted one hand to a patient who has had both hands and legs amputated years ago," he stated.
The procedure consists of three distinct stages: the first involves detaching the hand from the donor, the second is the preparatory surgery on the recipient, and the final stage focuses on attaching the transplant. During this last phase, the surgeons first connect bones and blood vessels, followed by attaching tendons, nerves, and other structures—a process requiring immense precision and coordination.
Before undergoing the transplant, the patient underwent extensive evaluations to determine their suitability for the operation. After the surgery, they spent roughly a week in intensive care and continued on the general ward for several weeks to monitor recovery. Moving forward, the patient will require over a year of rehabilitation and multiple follow-ups at the hospital to assess the donor hand's functionality and sensation.
"The longer the recipient’s stump, the smaller the transplanted section needs to be, and the more favorable the functional outcome," Ryhänen explained, noting the particulars of their recent surgery which attached the transplant below the elbow. Although the initial signs of recovery are optimistic, he cautioned, “While flexion and extension of the fingers can be achieved, grip strength and fine motor skills will still be inferior compared to those of a natural hand.”
The success of this surgery wasn’t just down to the skill of the surgeons but also to the extensive preparation undertaken by HUS's multidisciplinary team, consisting of hand, plastic, and transplantation surgeons, along with specialists from anesthesiology and nursing. "Hand transplantation requires vast resources and deep knowledge of several specialties," said Markku Mäkijärvi, Chief Medical Officer at HUS. "Now, with the first hand transplantation successfully completed, the next step is to establish this type of operation as part of the services HUS provides.”
A pivotal aspect of hand transplants is ensuring compatibility between the donor and the recipient, taking factors such as tissue type, gender, skin color, and age all under consideration. The very first hand transplant globally was performed back in 1998, initially setting the stage for such complex procedures to flourish globally. Since then, approximately 120 hand transplants have been performed across Western countries.
While prosthetic technology has made impressive leaps, it doesn’t replicate the sensory feedback and dexterity of biological hands. This makes hand transplants particularly significant for patients seeking to regain functionality. Professor Ryhänen elaborated on the best outcomes of wrist-level transplants, stating, "The best functional results have been achieved in wrist-level transplantations where the patient's own functional muscles can quickly regain control of the fingers via the transplanted tendons soon after the surgery.”
HUS’s preparations for this groundbreaking surgery have spanned several years, with surgeons practicing techniques with cadavers and studying international hand transplant methodologies. Moving forward, HUS aims to incorporate hand transplant procedures as standard offerings within their healthcare services, underscoring Finland’s progressive advancements in transplantation surgery.
