Hand Transplantations and Bionic Prostheses

Recently I attended an international medical student congress, Medical Student Journal Club – Pro et Contra, which took place on 23. and 24. May 2014 in Ljubljana, Slovenia.

It was a great congress, with a lot of interesting debates preesented by great speakers.

Myself, I have also registred as an active speaker, together with a colleague of mine, Barbara Šijaković. We debated on topic “Reconstructive surgery should focus on development of cadaver body parts transplantation rather than bionic prosthesis implantation“.

Below is a transcript of our debate.

And just for elaboration, the whole keynote was actually made with only videos tu support theses.

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Reconstructive surgery should focus on development of cadaver body parts transplantation rather than bionic prosthesis implantation

Luka: Hello, it’s me up here again. So, I thought I could start with an old Marx brothers joke. No wonder it looks like the same room, because it is the same room. Ok, it doesnt go…

Well, since it’s Saturday afternoon and this is the last debate of this congress, we’ll try to be as interesting and short as possible. My name is Luka, on my left a college of mine, Barbara, and, already introduced, our mentor, Nina Suvorov, MD.

Before we actually start with the debate, let us ask you a question. Imagine you’ve lost your hand sometime in the past and now you are presented with two options. Either hand transplantation or bionic prosthesis. Which would you, right now, choose. Would you go for hand transplantation, or would you rather go with a bionic prosthesis. How many of you would choose hand transplantation? And how many bionic prosthesis? Interesting; 60% for bionics and 40% for transplantation. We’ll keep that number in mind.

Barbara: Now, before we begin, let’s clear the terms. Luka, could you tell us what a reconstructive transplant is?

Luka: Thank you, Barbara. A reconstructive transplant, or also called a composite tissue allograft, is an operation that involves transplantation of bone, tissue, muscle and blood vessels. According to WHO “transplantation is the transfer or rather engraftment of human cells, tissues or organs from a donor to a recipient with the aim of restoring function(s) in the body. And in cases when transplantation is performed between different species, e.g. animal to human, it is named xenotransplantation.”

Now, Barbara, would you care to briefly explain what a bionic prosthesis is and how it works?

Barbara: Bionic creativity engineering is basically implementation of biological systems in the developing modern technology. Bionic hand isn’t just the hook. It mimics the real human hand. In some cases bionic hand even superposes human hand, as we shall see later.

There are different bionic prostheses, today I’ll talk about i-Limb Ultra, the one most advanced for now.

Here is how it looks: we can see power button here, the digits are motorized. It’s made out of plastic, titanium and silicone.

And just some mechanical properties…

This is a myoelectric prosthesis, which means it uses electrical sensors to detect contractions in the selected muscles of the residual limb. These contractions are than translated into movement of the bionic hand by a specific algorithms.

Luka: Ok, so which is better? Let’s start with transplantations of the hand. We will focus mainly on the hand, since leg prosthetics are nearly perfect, but with hand it’s different. You have many small and fine movements that are incorporated in every day’s life and you simply cannot function without a hand.

Just some short history for the beginning. The first hand transplant was actually performed in Ecuador in 1964, but the patient suffered from transplant rejection after only two weeks. Then, there was basically a long period of nothing. Up until January 1999. The first successful hand transplantation. Now, you should notice, we are talking about transplantation, not about replantation. The first successful replantation was performed in Shanghai, China, in January 1963.

So, in January 1999 the first person (a baseball player) underwent an operation. This kind of operation is probably one of the longest there is. It takes approximately 12 to 16 hours. In comparison, a typical heart transplant takes 6 to 8 hours and a liver transplant, 8 to 12 hours.

Hand transplantation is an extremely complex procedure, but may not be as difficult as a hand replantation in that a replantation usually involves crushed or mangled bones, tendons, and ligaments.

Barbara: Would you care to elaborate on how this is done?