Sheba offers tendon transfer surgery

Exclusive: Procedure may restore hand use of quadriplegics.

By JUDY SIEGEL-ITZKOVICH
surgery 88 (photo credit: )
surgery 88
(photo credit: )
Sheba Medical Center at Tel Hashomer has begun to offer tendon transfer surgery for restoring the ability of quadriplegics to grasp and pinch objects with their fingers. The complex surgery, developed by an Australian Jewish plastic surgeon who lived for a time in Israel, could eliminate or reduce the dependence of some 1,500 Israelis who will be able to eat, write and even drive by themselves instead of having a round-the-clock caregiver. The first Israeli hand tendon transfer surgery was performed Monday by Dr. Yona Yaniv, who recently returned from Australia, where she learned the technique. There, she watched and participated in operations conducted by Prof. Gerard Sormann, a French-born Australian surgeon. Sormann supervised when Yaniv performed the tendon transfer on an Israeli man who developed a neurological tumor on his spine that was removed at the Mayo Clinic. However, he was left with partial paralysis of his legs, and his hands were floppy and useless, Sormann told The Jerusalem Post. After Yaniv's operation, the patient's arm was put into a cast for three weeks. This will be followed by intensive physiotherapy and occupational therapy, after which he is expected to be able to use his hand for grasping objects and no longer be completely dependent on a caretaker. Wrist and hand tendon transfer surgery involves rerouting the forearm muscles that have retained movement and power and grafting them to the tendons used for moving the wrist, fingers and thumb. This allows the patient to both open and close his fingers and to grasp objects securely. This restores a significant amount of hand function in many people. Sormann said that since he developed the technique about 25 years ago, he has performed over 500 operations. He is one of the few in the world who knows how to do it, but now he has taught Yaniv, who said she was ready to operate on one patient per month. Much simpler kinds of single tendon transfer are already performed in Israel, so the Sormann procedure will be covered by health funds as part of the basket of health services and by the Defense Ministry for veterans. The main qualification for the surgery is that the spinal cord damage was at the C5 or C6 vertebra. Sormann, who can read Hebrew and speaks some, came on aliya with his former wife a few decades ago and left the country because she was unhappy. He went to Australia, where he studied surgery and was able to develop the technique, which he has now transplanted to Israel. He contacted Prof. Mordechai Shani, former director-general of Sheba, and offered his teaching services; Yaniv was invited to go to Australia for two weeks to learn how to perform the eight-hour operation. In tendon transfer surgery, the tendon of muscle that is not paralyzed is transferred to the tendon or tendons of paralyzed muscles so that the transferred muscle will be able to replace the function that was lost. When a tendon is transferred, its former action will be weakened, so it's important, Sormann said, to choose the proper muscles for transfer, just as a piano tuner decides which strings to tune. Because the operation is not always successful, quadriplegics may fear losing some of their powers after the transfer. "So we start on the hand that is not dominant, so they can see the improvement, and then they agree to have the other hand done," Yaniv said. "I have patients who can feed themselves, push their own wheelchairs instead of being pushed, drive a car, go to work and smash soft drink cans after drinking from them," said Sormann. "They develop tremendous self-esteem after being totally helpless." In the future, he expects that functional nerve stimulation systems will become available for patients who have higher levels of paralysis. These implanted wireless devices, now being developed, will function in quadriplegics like bionic parts. "My mission is to get the surgery under way here and find an Israeli company to collaborate on remotely controlled implants. I am glad that Sheba will be the national center to perform the surgery."