The Operation
It all happened on the evening of the 25th July, around 10 p.m.: five teams started simultaneously in two operating theatres - one group each on the left and right side of the donor and host and an additional team removing a leg artery from the donor. First they had to expose each of the muscle ends, nerves and the vessels and prepare them for connection. Before the donor's bones were severed, the blood vessels in the arms were filled with cooled preservation solution (perfusion). Both arms were then removed in such a way, that they accurately corresponded to the patient's arm length. Now both surgical teams connected the new body parts to the body of the host on both sides in a step-by-step procedure. First they joined the bones together with an 8 hole plate. They then connected the arteries and veins in order to recreate circulation of the transplanted arms as quickly as possible. The left side had already been prepared with three venous bypasses. Before completion of the anastomoses, the arms were rinsed with a special liquid to remove the preservation solution. Then the blood was released at intervals of 20 minutes; because from an anaesthetic point of view it must be ensured that the patient does not suffer acute damage from the blood flowing back from the transplants. The arms quickly took on their rosy colour. There was no significant swelling - proof for a well-functioning circulation and a short ischemia period (lack of tissue circulation). The surgeons then sewed the muscle and tendon strands back together and finally reconnected all the nerves (nervus musculocutaneus, nervus radialis, nervus ulnaris and nervus medianus). Now the skin could be sewn back together. Finally, a cross-joint fixateur externe was attached with pins to the lower and upper arm. This allows the arms to be suspended to avoid pressure marks. The operation was successfully concluded after 15 hours