World 1st: Two-arm transplant

Yeh haath mujhe de de thakur, screamed Gabbar Singh even as he chopped off the hands of the man who had once nabbed him and sent him to jail. Watching thakur (Sanjeev Kumar) wrapped in a shawl, stoic and helpless, is among the most indelible images of Sholay, Bollywood's biggest blockbuster ever. Now consider this. What if technology helped give thakur a new pair of arms? Would he still have hired Viru and Jai to capture Gabbar? Or would he have himself embarked on a mission of revenge.

Well, such a possibility is no longer in the realm of fantasy. A German medical team said on Friday that it had performed what it called the world's first transplant of two full arms, on a farmer who had lost both his limbs in an accident. The donor was a 15-year-old boy who had died before the farmer's operation. The patient, 54, was "doing well under the circumstances" after the 15-hour operation on July 25-26, a spokeswoman for the clinic at the Technical University in Munich said.

The amputee, who had lived without arms for six years since the accident, consulted the 40-member team at the university's Rechts der Isar Clinic after two failed attempts to use artificial prostheses. "The man required round-the-clock assistance — a condition he wanted to change as quickly as possible," the clinic said.

The head of the transplant team, Christoph Hoehnke, said he was deeply moved as the man's wife went to his bedside after the operation and instinctively reached for his hands. "They look just like they used to," she said.

Two years before new hands get fully functional

Doctors said it could take two years before he "really has feeling in his fingertips again" because the transplanted nerves must still grow.

The facility has a decades-old unit for microsurgery and replantation surgery, with a speciality in interdisciplinary operations it said was essential for a procedure of this complexity. Professor Hans-Guenther Machens had prepared the transplant since he became the clinic's director in December.

Doctors said suppressing the man's immune system so it would not reject the new limbs was a key concern. Another challenge was finding a donor who matched the patient's sex, age, skin colour, size and blood type.

Five teams working in two operating rooms gathered at 10.00pm the night of the operation, divided between the patient and the donor, who had died only hours before.

The first step was to expose the muscle, nerves and blood vessels to be connected. Before the bones of the donor could be cut, blood vessels in his arms were filled with a cooled preservation solution.

Both arms were then removed exactly at the point matching the patient's arm stumps. First the bones were joined, then arteries and veins to ensure blood circulation as quickly as possible.

"The arms quickly resumed their rosy colour," the spokeswoman said. The surgeons then attached the muscles and tendons, then the nerves and finally the skin.

The doctors will now monitor how the wounds heal and whether infections, side effects from medication or any other rejection by the immune system occurs.

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