The outcome of the first medical review two months after the world’s first successful double arm transplant was positive, said the surgical team that gave a 56-year old German farmer, Karl Merk, two new arms to replace the ones he lost in a farming accident six years ago. The donor was a teenager who died before having surgery.
On 26th July 2008, the Klinikum rechts der Isar of the Technischen Universität München, succesfully performed the world’s first complete double arm transplant. The operation was carried out by a 40-person team under the leadership of senior surgeon for plastic and hand surgery Dr Christoph Höhnke (who led the transplant team), and Professor Edgar Biemer, a longstanding former head of the plastic surgery unit.
Now, a good two months later, Merk was happily talking to the press, with his two senior surgeons, about his first medical review.
A statement from the clinic emphasized the enormity of the procedure: the surgical team stepped into new territory when they undertook the largest transplant of human limbs ever performed. Recipient and donor had different immune systems and the risk of an adverse skin and bone reaction was not insignificant.
But thanks to a special immune suppression procedure carried out by Dr Manfred Stangl (leader of the transplant department at the clinic), no adverse reactions have been observed either during or since the operation, and the immunosuppressant medication is gradually being reduced.
In the first week following the operation, the main concern was wound healing and getting the patient to move around. Within a few days of the procedure, Merk was already able to leave his bed, said the statement from the clinic.
The next priority was then to regenerate the nerves and stop the muscles from wasting away. Merk had to work hard to keep the muscles of the arm working, by doing hours daily gym exercises as well as undergo electrical stimulation of all the arm muscles.
This regimen demands a lot of patience: the nerves only regenerate at the rate of 1 mm a day, so at the earliest, it will be 1.5 to 2 years before Merk will be able to move his arms in any way, the doctors told the press.
The doctors said they were modestly optimistic, as Höhnke explained: “the nerve regeneration appears to be progressing well, the patient is starting to get what he describes as a “tingling feeling” in his upper arm, just under the join”.
In the meantime, Merk’s arms are supported in front of him with a sort of mobile scaffolding. As he himself explained:
“I can hardly remember now what it felt like not to have any arms.”
Merk hopes to be home again soon, on his farm. This could be in four to six weeks, if the good progress that has been made so far continues, said his doctors. But even after this, he will still be doing several hours a day of strenous physiotherapy.
Höhnke said that it was a case of “two arms, one team”, and he was glad he could rely on the help of several heads and pairs of hands to perform the transplant; he said he looks “forward to the day that our patient, as a former milk farmer, fulfils his own wish, to drink a glass of milk with his own hands”.
(“Ich bin zuversichtlich, dass sich unser Patient als ehemaliger Milchbauer eines Tages seinen sehnlichen Wunsch erfüllen und mit eigenen Händen wieder ein Glas Milch trinken kann.”)
Source: Klinikum rechts der Isar, Technischen Universität München, MNT archive.
Written by: Catharine Paddock, PhD.