Wednesday , June 16 2021

Tetraplegics can move their hands again – a luminary in Nottwil makes it possible

Thanks to new methods, quadriplegics can move their arms and hands again. Such operations can only be performed by about 30 surgeons worldwide. Jan Fridén from the Swiss Paraplegic Center in Nottwil is one of them.

Niels Jost

Hand Surgeon Jan Firdén has already performed surgery on over 1200 tetraplegics, so they can partially move their hands again. (Photo: Nadia Schärli (Nottwil October 30, 2018))

Hand Surgeon Jan Firdén has already performed surgery on over 1200 tetraplegics, so they can partially move their hands again. (Photo: Nadia Schärli (Nottwil October 30, 2018))

Jan Fridén is a sought after man. He does not have the time for an interview. The employment is therefore arranged several weeks in advance. It is therefore surprising how the hand surgeon occurs at our meeting in the Swiss Paraplegic Center (SPZ) in Nottwil: T-shirt, casual training pants and finches. Fridén looks charismatic, relaxed, but his eyes are focused. He has just been on the operating table, explains Swede, but his colleagues in the hand and tetrahedral operation are continuing the procedure.

Although Fridén speaks good German and even a little Swiss German, we speak in English. So he could better explain how it is possible that quadriplegics can move their arms and happen again limited – and why one in five decided against such an OP.

Jan Fridén, you are considered a luminary in tetrahedral surgery, has performed approximately 1200 hand constructions in patients with spinal cord injuries. Only about 30 surgeons around the world can do this – although the method has been known since the 1970s.

At that time, the method gained some attention. Just 10 years ago, the technology for transmission of the nervous system resumed and since then it developed continuously. My technique is unique because we can do it with just one surgery so that the patient can open and close the fingers without using the original muscles or tendons. This is done by placing the muscles or nerves in another position.

What patients do you and your sex person show on SPZ?

People with spinal cord injuries but also in the brain come to us. People who have no or limited arm and hand functions. Whether it is due to an accident, illness or infection, we can recover all or part of the hand's functions. There are three surgical methods: We either change muscles, tendons or nerves and reassemble them.

"If you can move your hands again, you will regain a huge quality of life."

How does it work?

The method we use depends on how much the spinal cord is damaged. For example, if the paralysis is relatively deep, a muscle transfer will be questioned. We move an intact muscle from the upper or forearm to a place where it can perform central functions, such as bending your fingers or closing and opening the fist.

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

The muscles are fully functional. They just need an impulse. For this we cut off an intact nerve and insert it on the non-functioning nerve. The nerve grows again – up to a millimeter a day! We make sure that the growing nerve finds the target muscle, which in turn allows the mentioned hand functions.

Interview canceled. Fridens mobile phone rings. "This is the surgery cottage, I have to get there quickly," he says. Some advice later, he focuses again on the conversation, but says: "In 30 minutes, I have to be back in the operating cottage, is it possible?"

How long does an operation take?

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

What do you mean?

Following this complicated surgery, patients must stay in SPZ for up to three months and then spend several months in the ambulatory area. Say: Away from home, back to the clinic. This is the main reason why about one in five reject an operation.

How long does the rehab process take?

The patient must revive all the arm and hand functions. It takes up to 12 months – and it's hard work. Even for simple everyday actions, the movements are extremely complex. For example, if you want to lift a glass you must first stretch your arm, open your hand, hold the glass with enough pressure and finally turn the glass off again. It takes a lot of time and balance.

"If someone is not willing to meet the learning process, the operation will not help."

Is your method always successful?

If someone is not willing to meet the learning process, OP does not help. But before each surgery we do tests and a prediction that works as the patient will regain. A 100 percent recovery of skills is hardly possible, but in any case, we will achieve an improvement.

It means?

If you can move your hands again, you will regain a huge quality of life. Be it when you can shake hands of others or hug them, or even for communication, for example with a mobile phone. In addition, patients can move their own wheelchair. Such interventions change the patient's entire life and environment. That motivates me to go to work every day.

Does the insurance cover the procedure?

Yes, but we must tell the insurers exactly what skills the patient will receive. But only when someone can get dressed again, this health system relieves in the long run.

Recently, the media reported that a paraplegic could go again thanks to an ETH treatment. Would that also be possible with your method?

No. The legs carry full body weight. At the moment, we can not achieve as much muscle mass through muscle or nerve transmission technology.

Nevertheless, modern drugs seem to have no limits. How far will this go? Also, play ethically in your work
Principles and Role?

Of course. On the contrary, I wonder how I can give as many people as possible access to such modern methods. These are only available in about 15 countries worldwide. It would be great if there was much more.

You have been to SPZ since 2011, previously you led the Center for Tetrahand Surgery at the University Hospital in Gothenburg, your home. Why the change to Nottwil?

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

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

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