Jan Frieden is a wanted man. There is really no time for an interview. Therefore, the appointment is scheduled for several weeks in advance. It is therefore surprising that a hand surgeon appeared at our meeting at the Swiss Paraplegic Center (SPZ) in Nottingen: a T-shirt, a casual trainer of pants and pastries. Frieden looks charismatic, relaxed, but his eyes are focused. He was just on the operating table, explains the Swede, but his colleagues from the Department of Manual and Tetrahedral Surgery are now proceeding.
Although Frieden speaks a good German and even little Swiss German, we speak English. So he could better explain how it is possible for quadriplegics to shift hands and hands again – and why one in five opted against such an OP.
Jan Friden, you are considered a witness in tetrahedral surgery, you have performed about 1200 reconstruction of the arm in patients with spinal cord injuries. Only around 30 surgeons around the world can do this – although the methodology has been known since the 1970s.
At that time, the method got too little attention. Just ten years ago, the technology of nerve transmission was continued and has since evolved. My technique is unique because we can do this only with one operation, so the patient can open and close his fingers without the use of original muscles or tendons. This is achieved by placing the muscles or nerves in a different position.
Which patients do you deal with with SPZ and your six-member team?
People with spinal cord injuries as well as brain come to us. People who do not have or have limited hand and hand features. Whether it's due to an accident, illness or infection, we are able to recover all or part of the hand features. There are three surgical methods: we either shift muscles, tendons or nerves and reassemble them.
"If you can move your hands again, you will bring back the enormous quality of life."
How does it work?
The method we use depends on how much the spinal cord is damaged. If the paralysis is relatively deep, for example, muscle transfer has been put into question. We move the intact muscle from the upper or lower arm to a place where it can perform central functions, such as bending your fingers or closing and opening a fist.
This means that tetraplegic muscles are paralyzed but still intact?
Mice are fully functional. It only needs one impulse. For this we cut off the intact nerve and put it in a dysfunctional nerve. Nerv grows again – up to millimeter a day! We ensure that the growing nerve finds the targeted muscle, which in turn allows the aforementioned functions of the arm.
The interview was interrupted. Frieden's mobile phone is ringing. "This is the operating room, I need to get in quickly," he says. Some tips later, again focuses on the conversation, but says: "In 30 minutes, I have to go back to the operating room, is that possible?"
How long does the operation last?
Five to six hours. But that is not enough.
What do you mean?
After this complex operation, patients must remain in the SPF for up to three months, and then spend several months in the ambulance. Say: Far from home, back to the clinic. This is the main reason why about one in five rejects the operation.
How long does the rehabilitation process last?
The patient must release all functions of the arm and arm. It takes up to 12 months – that's hard work. For even simple actions in everyday life, movements are extremely complex. For example, if you want to raise a glass, first you need to extend your hand, then open your hand, hold the glass with enough pressure and finally turn off the glass again. This takes a lot of time and balance.
"If someone is not ready to face the learning process, the operation will not help."
Is your method always successful?
If someone is not ready to face the learning process, the OP will not help. But before each intervention, we perform tests and prognosis of which patient's function will return. 100% skill recovery is difficult, but in any case, we will achieve improvement.
If you can move your hands again, you will regain a huge quality of life. Let it be when you can handle some hands or embrace them, or even for communication, for example with a mobile phone. In addition, patients can move their own wheelchair. Such interventions change the whole life of the patient and his environment. It motivates me to work every day.
Does the insurance pays the procedure?
Yes, but we have to tell the insurers exactly which skills the patient will return. But only when someone can dress again, this makes the health system easier in the long run.
Recently, the media reported that a paraplegic could walk again with ETH therapy. Would that be possible with your method?
Not. Legs carry whole body weight. At the moment, we can not reanimate so much muscle mass by a technique of muscle or nerve transfer.
Despite this, modern medicine has no limitations. How far does this have to go? You also play ethical in your work
Principles of role?
Of course. On the contrary, I wonder how I can give as many people access to such modern methods. They are available only in 15 countries of the world. It would be good if it was much more.
You have been in the SPZ since 2011, you were previously head of Tetra-Hand Tetra-Hand Center at the University Hospital in Gothenburg, your home. Why change to Notting Hill?
The Center for Competences with the Department of Hand Surgery in Nottingham is unique in Europe. Our team consists not only of surgeons, but also of physiotherapists and professional therapists, researchers and doctors.
After 60 minutes the interview was completed. Frieden stayed only 5 minutes in a photographic session. "Then I have to go to the operating room."