Tuesday, October 18, 2011

In Massachusetts, quadruple amputee receives hand transplants

From the Boston Globe:

A 65-year-old man who lost his lower arms and legs to a terrible bloodstream infection in 2002 received two new hands during a 12-hour transplant operation at Brigham and Women’s Hospital last week.

The Brigham announced the surgery this morning during a press conference, where the patient, Richard Mangino of Revere (pictured), spoke to reporters.

“It’s just like you can fly,” he said. “It’s like a bird that got its wings back.”

While he spoke, his new hands and forearms were visible, propped up on pillows as he sat in a wheelchair.

Mangino said that it took two days after the surgery for him to adjust to seeing his new hands and that at times it is still surreal. He said he’s begun to feel his new wrist and fingers for brief periods, but it will take months of rehabilitation for him to be able to use his arms.

Forty surgeons, nurses, anesthesiologists, residents, radiologists and physician assistants attached the left and right forearms and hands from an anonymous donor below Mangino’s elbows, including bones, skin, tendons, muscles, ligaments, and blood vessels. The Brigham did not reveal the exact date of the operation to shield the donor’s identity. This morning, the surgeons said Mangino was recovering well.

During an interview with the Globe in August, Mangino -- who became a prolific artist after his amputations -- said he wanted new hands so he could experience the sense of touch again, resume playing the guitar and swimming, and “ride a bike without bumping into everybody else.”

Even as a quadruple amputee, he tirelessly taught himself to do many of the things others take for granted, from dressing himself to picking up a dime from the floor. He relishes that he mastered shoveling waist-deep snow from his walkway last winter. But daily life was exhausting.

“I just want arms to be able to change my clothes without having to think how I am going to put them on, everyday,’’ he said. “Everything is a challenge.”

Mangino, who grew up in East Boston, has three grown sons and two grandsons.

His operation was the second double hand transplant attempted by the plastic surgery team at the Brigham, which has so far focused on face transplants. In May, the team transplanted an entirely new face and two hands onto Charla Nash, a Connecticut woman who was attacked by a chimpanzee.

The face transplant was successful, but the hand transplant failed when Nash experienced an unusual cascade of complications that began with pneumonia after surgery. She developed sepsis, a bloodstream infection, and her blood pressure dropped so low that her new hands were starved of blood -- similar to what happened to Mangino a decade ago when he lost his own lower arms and lower legs.

While the Brigham runs the busiest face transplant program in the United States and one of the largest in the world, a number of hospitals in this country and abroad have done hand transplants for years.

Dr. Bohdan Pomahac, director of plastic surgery transplantation at the Brigham, said that worldwide, more than 50 hands have been transplanted onto about 30 patients -- some were double hand transplants. About a dozen of those hands have been transplanted in the United States, he said. Generally, the results have been good, with 98 percent of patients gaining sensation in their new hands. Patients whose amputations were close to the hand, rather than farther up the arm have the best outcomes and often are able to move their new hands and grasp objects.

Aside from Nash, a couple of other patients have lost transplanted hands due to various complications, including one who stopped taking immunosuppresant medications that keep a patient’s immune system from attacking the new tissue, Pomahac said.

Before he got sick, Mangino was in charge of the ground crew for United Airlines at Logan International Airport. He said he had a kidney stone in March 2002, which developed into sepsis. He almost died, but doctors at Massachusetts General Hospital used powerful medications to put Mangino into a coma to help him heal. The infection ravaged his body, however, depriving his limbs of blood.

He remained in the hospital for two months as doctors tried to save his limbs, regularly unwrapping his bandages and rubbing his legs and arms with oil. Their attempts failed and in July 2002, surgeons amputated his legs about 8 inches below his knees, and his arms about 6 inches below his elbows.

Mangino’s eyes well up with tears when he talks about that time. Suicide briefly crossed his mind when he woke from the coma, because he didn’t want to burden his family, but he has since regained his zest for life.

When his prosthetic legs were being fabricated, Mangino was asked how tall he had been. Five-foot-10, he replied, inflating his height by three inches.

“I already lost a lot,” he said during the August interview, flashing an impish grin. “And everybody wants to be taller.”

Mangino is passionate about music -- he played guitar in bands in the 1960s at Revere Beach and still composes music -- and has a keen interest in art. He began painting regularly after his amputations, holding a brush in the prosthesis he attaches to his left arm, and he displays his works proudly on his basement walls and on a website.

He works out at home four times a week for one-and-a-half hours a day, using a treadmill, bike, and weights. His regimen includes between 500 and 1,000 sit ups, he said.

About a year ago, his wife, Carole, saw news stories about the face transplants at the Brigham. She immediately called the hospital and told doctors about her husband.

Over the past year, Mangino has undergone a battery of psychological and physical tests in preparation for the surgery.

Now that he’s had the transplant, he will return to the Brigham for five days a week for rehabilitation for 18 months.

While Mangino said before the operation that he was eager for new hands, he did not let his disability tear him down.

“There’s a million good things that have happened in my life, my marriage, my kids, we’ve gone to Disney, white water rafting,’’ he said during the interview. “And I am going to let one thing ruin my life?”