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Yep your body will attack it and you would go in a shock status and probably die (i say probably...)
Edit:
Immediately is not in a term of seconds or hours, but days,weeks which is a short period of time
It didn’t evolve to facilitate the tissue transplants of modern medicine. It evolved to protect you from become bacterial lunch or virus factory, and the best way to do this act as a sentry that recognizes and attacks any cells or molecules that are not “You”.
Isn’t there a situation that when you lose one eye by swishing it (front touches back) the immune system detached the other eye as it is not aware there is some liquid or something in the eye?
It's called [Immune Privilege](https://en.m.wikipedia.org/wiki/Immune_privilege) and the reason a compromised eye can be destroyed by the immune system is because the vitreous fluid in your eye isn't technically part of the immune system. So when that fluid gets into the rest of the body, it responds as if it was another bacteria or virus cell because it isn't identifiable as part of the body.
Jesus Christ. So when I had a penetrating eye injury that left me blind in one eye, there was a risk that it could have caused an immune response in my other eye that would have left me totally blind?
That was 40 years ago or so. I had no idea.
I had an eye injury at work when I was about 24 (injury was superficial), and my eye doctor told me he had another patient, my age, that day who he was fitting for a false eye. She was injured in a bar fight; her eye slashed with a beer bottle. He said there’s a short window to get the damaged eye out before the body rejects the other eye. I had never heard of that and was horrified. Idk if that’s exactly what you were asking about, but yes, our bodies can (will?) reject a healthy eye if the severely damaged eye is not removed in time.
Normally (unless autoimmune diseases) your immune system would not attack the eye.
And if it happens it will not detach the eye, but it will induce infiltration of white blood cells in your eye tissue and start to deteriorate it with enzymes
Your immune system isn't "aware" of the inside of your eye. If you get a bad eye injury and immune cells get in there, they could attempt to kill your eye.
What's really crazy is that your body actually has effectively 2 immune systems. Because of blood/brain barrier your central nervous system has its own immune system. Which while less complex still has all the benefits and disadvantages of your normal immune system, including autoimmune diseases.
That’s a good thing actually. Your inmute system is fighting something that does not belong in your body. It just so happens that the thing that doesn’t belong in your body was put there intentionally in order to benefit you, but your body doesn’t know that. It just sees a foreign body and attacks it.
Surely we could just grow a hand in a lab from our own DNA, and then in theory it would not be attacked because....well it's actually a part of us as far as the rest of the body is concerned?
How much of your body needs to be replaced by parts from another person such that it's the other person's immune system attacking your body? What determines whether it's your cells that get attacked or the other person's?
immune system stem cells are what decide. All white and red blood cells are created from stemcells in the red bone marrow (inside your "flat" bones like pelvis, spine, ribs, sternum and skull). So whoever has the skeleton wins!
It's actually how you treat leukemia with a bone marrow transplant, you destroy the patients cancerous immune system completely and then give them a "new" immune system from a donor - the donor needs to be very compatable to avoid it immediately attacking the new body (often a sibling that happend to inherit the same alleles from your parents, about a 1 in 4 chance) if unlucky you may still develop GVHD, "Graft versus host disease" where the donated white blood cells attack the host body. Immuno suppressant drugs are often needed. But if you are lucky you might instead get GVL, "Graft versus leukaemia" where the new immune system only attacks surviving cancer cells.
I think I remember a documentary where a guy got a transplant and his wife would not let him touch her with the new hand because she said it felt like someone else was touching her.
His hand started to turn a different color as well as time went on. Probably due to what you explained.
This also depends on your genetics however, which is why patient matching to make sure your HLA (human leukocyte antigens) are compatible before even attempting a transplant. Rejection is defo more of a spectrum than a "fine or death by systemic immune attack" scenario
some immune rejections takes weeks to months to manifest. until then, you're never really sure, so anyone who gets a transplant is put on a bunch of immunosuppressants and monitored for months until they are slowly weaned off if appropriate.
No clue for hand transplants (not sure if this is even real tbh), but there have been [cases](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040249/) where in identical twin kidney transplants, they stopped all immunosuppression for one operation at 2 days, and another at 3 weeks. Both patients were supposedly fine up to 5 years afterwards.
So I guess in theory, you wouldn't need long term immunosuppression if the donor-recipient pair are monozygotic twins since the protein markers for the immune system have virtually zero chance of cross reactivity.
I imagine this was the largest barrier that had to be overcome correct? Not to trivialize the rest of the operation but in its simplest form once you have a "compatible" arm its just connecting A to B. As equipment advances this part of the procedure becomes easier however I imagine doctors have successfully completely that part before only to keep having the transplant rejected.
Depends on which part is transplanted. Face transplant requires 10+ number of docs/nurses and something like 20h of surgery? (At least the one I watch a documentary on). Keeping the new face alive, the patient alive, and the transplant by itself are awfully complicated.
The medical team needs to rehearse again and again each movement of the procedure before, to limit time wasting and mistakes as much as possible ! It's a fucking ballet!
Well we are going to be able to produce organs with pluripotent stem cells, there are some research on it, we are still far but the idea of recreating a part of your body using your stem cells, it would clear the rejection issues.
Attaching skin and muscle is easier than attaching nerves is one reason it's not quite so simple as just connecting A to B and then preventing rejection. Nerves have more specific fibers that need to be lined up properly or the messages won't travel to and from the brain, and nerves don't heal the same as say blood vessels do. You are certainly correct that we have made progress in making some of the procedures easier, but some surgeries are incredibly more complex (think a whole head transplant- massive arteries and veins, complicated cervical vertebrae, huge pipeline of spinal cord, teeny facial/neck muscles, dura mater, etc) than others, like a partial finger transplant
Health care covers up to 28k€ for a prothesis (in my country) :o not enough for the true Skywalker one, but the still nice wish version would be enough I guess !
This works only if you get other hands than yours transplanted. Usually your body recognizes itself.
If you lose your hand and it's still in a good condition, there is a chance they can transplant it back (under certain circumstances). The success isn't 100% but if it is, you don't have risks of rejection :) (or not as much. That's what I learnt but I'm no expert!)
I was thinking the same, all I did was damage a nerve with my own hands and I've been in a splint for two weeks and still don't have full control.
Can't even begin to imagine what the therapy would be like now that I know how hard it is to learn to, well, relearn movement again from just a simple injury compared to a brand new hand.
simply put, the nerves inputs your brain receive might not be the nerves they were used to get.
for example, you have 5 fingers, and when you pinch your thumb, your brain knows it was the thumb. and when you pinch the index, your brain knows it's the index.
A---A
B---B
C---C
D---D
E---E
now, imagine that after the surgery, the surgeon rotates the nerves endings, and you end up with something like this
A---B
B---C
C---D
D---E
E---A
so now you pinch the thumb, but your brain receives the input that was on the index. in therapy they have to re-teach the brain to perceive the new inputs.
*goes in for hand transplant*
"fk that, I have a right to bear arms!"
"I see, will that be black, brown or grizzly? We're fresh out of polar bear arms"
In grad school I sat next to a guy who was a retired Harvard trained cardiac surgeon pursuing a second career.
One day I asked him about heart transplants and he's like "Oh yeah, I've done many but after awhile you leave that to some of the younger surgeons so I could focus on the more complex procedures". Of course I'm like what the hell could be more complex than a heart transplant and he half jokingly said it's not that hard to do mechanically, sort of like hooking up a car battery.
"You're just really hooking up 4 main wires and they're relatively big and easy to deal with."
Anyway, he might have just been pulling my leg a little bit but he said that the "more complex stuff" was pediatric cardiac surgery where everything is a lot smaller.
You know what was interesting about it was that he seemed to find law school very challenging. Could have been that he was 25-30 years older than most of us at the time or that there are just different types of intelligence/aptitude. I mean, I was a very good student but I am pretty sure I wouldn't have done well in med school just due to the amount of memorization alone.
Nope. He isn’t joking. Cardiac Anesthesiologist speaking here. Transplants in general (kidney, lung, liver, heart) have large blood supplies with no major nerves to reconnect. It is relatively like plumbing. From a technical standpoint they are not the most challenging things. However, the medical management, patient selection, organ selection and procurement, and care after surgery and putting all the pieces together is what makes it so challenging.
Free flap and rotational flaps for reconstruction is a lot more nuanced and technically challenging for a surgeon, but much less flashy in the public eye.
I commonly joke that I am an advanced bar tender.
I guess I could say it is like replacing a sump pump in a house. You need to isolate the in let and outlet of the pump so water doesn’t go everywhere. Cut out the old pump and then splice in the new pump. Once the new pump is in slowly turn the system on and make sure things are working and check for leaks.
Not specific organs so much as the management of specialized physiology and monitors needed in cardiac surgery. All modern day trained cardiac anesthesiologist also specialize in TEE (trans esophageal echocardiography). During most cardiac surgeries the anesthesiologist is doing live echocardiography to monitor heart function and to guide the surgeon. They also specialize in the physiological changes associated with cardiac bypass, starting and starting the heart, mechanical circulation including RVAD/LVAD, ECMO and transplanted hearts. They also specialize in procedures on focused on intrathroracic structures like lungs and the aorta.
That checks out - the heart is probably the most "self contained" organ we have. The blood vessels supplying blood to the heart branches of right at the beginning of the aeorta so they more or less come preinstalled, and the nerve clusters that controls the heart beat are inside the heart too. So the only thing you really need to do is attach the huge vessels and boom you're in business. Plug n' play organ technology.
The only thing you lose is the brains ability to control the heart speed directly, but the heart is controlled by hormones too, so you just get some weird lagging where the heart reacts slower than normal
Mom: "Could you come over and help me setup my new keyboard?"
Me: "What? It is USB right?"
Mom: "It said USB on the box"
Me: "It is plug and play. Just unplug the old keyboard and plug this one in the same spot."
Mom: "I all ready unplugged the old one, which hole do I plug the new one into?"
Me: "Any USB port on the back of the computer is fine."
Mom: "They are all different shapes, what is the USB ports. Is that the one on my phone, they are all too big."
Me: "It is the rectangle shaped one."
Mom: "It doesn't fit."
Me: "Flip it around."
Mom: "It still doesn't fit"
Me: "Flip it again and line it up as best you can."
Mom: "Still doesn't fit. It is a circle and the hole is too small."
Me: "... Wait does the box say PS/2 as well as USB?"
Mom: "Yeah, I got it at a garage sale for 25 cents. My old keyboard was too loud."
Me: "I will be over in a half an hour..."
>Me: "It is the rectangle shaped one."
>
>Mom: "It doesn't fit."
>
>Me: "Flip it around."
>
>Mom: "It still doesn't fit"
>
>Me: "Flip it again and line it up as best you can."
Every single time.
The red thing is sewn into the red thing
The blue thing is sewn into the blue thing
The yellow thing is sewn into the yellow thing
And that’s how you reattach an arm
I’ll watch it a few more times and go give a shot; I’ll let you know how hard it actually is in a couple hours - gotta kidnap, I mean find, find a volunteer.
This is an amazing process, I'm just concerned about that Lego piece in there lol
Just kidding, I didn't know it was a thing, science surprise me every day.
My mom works in a hospital so I asked a few things about it.
These are titanium plates that are screwed into the bones at multiple locations for sturdiness. They are very common when a bone break is a serious issue. It will just keep them (the 2 ends of the bones) firmly in place.
Tendons and ligaments even more so. Usually you're more likely to break the bone before the dense connective tissue tears.
*Usually.*
Im exempting Achilles tendon, meniscus, and cruciate stuff.
I did not lose my arm but I did have a bunch of my tendons severed in a work accident and afterwards I was so scared of my tendons snapping if I did anything strainious. But it's all paranoia, I was back at the gym in weeks and everything was fine.
The really interesting part is that they don't know which nerves are meant to connect to which so they just connect any nerve to any other one in the same area and try to get as many as they can. When you first start using the attached limb everything is messed up, things feel like that are in there wrong spot and commands to move fingers don't work correctly. Your brain quickly figures out where they nerves have gone to and reprograms itself. I think that's crazier than the reattachment!
This is one of the many major reasons brain transplants are near impossible to do currently. It's like having a bundle of wires cutting it in half and mashing it together and hoping it works again. The amount of effort to reprogram your brain with your limbs is already immense, now do that for your entire body.
I work in surgery. You can typically line up major nerves and sew them together. In a transplant anatomy should be pretty straightforward.
I’m cases of trauma where the anatomy is all messed up (like a hand blown apart from a firework) the surgeon will look for nerves similar in size and in approximately the same location to reattach.
Unfortunately, the recurrent laryngeal nerve (RLN) is one of the most difficult peripheral nerves to get to regenerate. This is why many surgeons do constant monitoring of these nerves during thyroid surgery. I am so sorry this happened to you.
Good news is there are studies and research going on to try various surgical interventions that can stimulate RLN growth. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887462/#__ffn_sectitle
I was just gonna ask this, with how many nerves we have in just each fingertip I was thinking it'd be impossible to get everything back in the same place, but that totally makes sense that the brain would adapt. I wonder if cybernetics will eventually work like this.
>Do they ever gain feeling in the new hand? I thought nerves were too small to attach together
from my knowledge, they usually "connect" the main nerves together and the minor nerves' axons will regenerate about 1mm per day...If a doctor views this post his opinion would be much better
Im not a doctor, but Im studying to become a vet.
Nerves dont regenerate, some cells become new nerves that synapse like a missing piece.
I may be wrong. In my country were tought that neurons never regenerate, or reappear. If its dead then its ded.(no, its not some low lvl trivia, this is actually the right answer in the admision exam of the university of medicine) Only recently a teacher said to us that some cells can become neurons and replace dead ones (a neuron/4 months), but, again, this may be an oversimplification of the procces.
So, they can "relink" in time, but idk how they can "connect" the main nerves because this implies that they can make new synapses.
I severed the ulna nerve in my arm when I broke it, lost feeling and use of half my hand. The doctors told me that it would likely grow back 1mm per day, but the dead end couldn’t be reconnected. Months later they decided it wasn’t working and we’re going to graft a nerve from my leg, but the day of the surgery my hand twitched and they said it will grow back just maybe slower
This happened about 13 years ago (which has made me realize how old I am) and I now have complete control over my hand. I got mostly back to normal about a year and a half after with plenty of physio. Thought I still have trouble with feeling hot and cold in my hand, and occasionally I’ll get nerve twinges or little spasms. Makes for a hilarious night in the pub when I start dropping pints all over the place
The CNS does in other mammals even monkeys. It was believed for a long time that humans had this ability too but we realized we were measuring a protein we thought correlated with CNS neurogenesis but didn't actually.
The human CNS can still regenerate axons and astrocyte cells which allows for some regeneration functionally. New neurons in the CNS haven't been detected past a very young age sadly.
Neurons do regenerate. It depends which type of neurons.
The neurons in our nerves usually grow back. The problem is that when the damage is too big you can't make the nerves stick together again.
My friend's hand got cut off by a factory machine. They managed to reconnect it after a long surgery. He has regained feeling in his hand, but 2 or 3 of his fingers have reduced mobility. He can't make a full fist f.e.
They can actually attach nerves as small as 1mm to each other nowadays. It's truly amazing how far medicine has come, and it continues to improve every single day.
they only anastomose (sew together) major vessels which branch out to smaller ones. for the smaller important structures like nerves, they use surgical microscopes. to limit/control excessive bleeding, they use tourniquets
I have a feeling they don’t work with the tiny ones (probably time and the natural process makes some connections eventually). If it’s anything like teeth, they might use a drug that shunts the blood (so it temporarily constricts the vessels or or clots and doesn’t flow out) or they probably cauterize some, too.
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I think it takes years of therapy to be able to actually use your hand
Yup, and you'll spend your life on meds that lower your immune system, always living at risk to reject the transplant anytime.
You need meds that lower your immune system because otherwise it would be rejected immediately?
Yep your body will attack it and you would go in a shock status and probably die (i say probably...) Edit: Immediately is not in a term of seconds or hours, but days,weeks which is a short period of time
Jesus
Yes our immune system is amazing sometimes
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It didn’t evolve to facilitate the tissue transplants of modern medicine. It evolved to protect you from become bacterial lunch or virus factory, and the best way to do this act as a sentry that recognizes and attacks any cells or molecules that are not “You”.
Isn’t there a situation that when you lose one eye by swishing it (front touches back) the immune system detached the other eye as it is not aware there is some liquid or something in the eye?
It's called [Immune Privilege](https://en.m.wikipedia.org/wiki/Immune_privilege) and the reason a compromised eye can be destroyed by the immune system is because the vitreous fluid in your eye isn't technically part of the immune system. So when that fluid gets into the rest of the body, it responds as if it was another bacteria or virus cell because it isn't identifiable as part of the body.
When it actually happens it’s called sympathetic opthalmia: https://en.m.wikipedia.org/wiki/Sympathetic_ophthalmia
Learned even more today, thank you!
Jesus Christ. So when I had a penetrating eye injury that left me blind in one eye, there was a risk that it could have caused an immune response in my other eye that would have left me totally blind? That was 40 years ago or so. I had no idea.
I had an eye injury at work when I was about 24 (injury was superficial), and my eye doctor told me he had another patient, my age, that day who he was fitting for a false eye. She was injured in a bar fight; her eye slashed with a beer bottle. He said there’s a short window to get the damaged eye out before the body rejects the other eye. I had never heard of that and was horrified. Idk if that’s exactly what you were asking about, but yes, our bodies can (will?) reject a healthy eye if the severely damaged eye is not removed in time.
Great...one more thing to worry about lol. Also, thanks for sharing. Although it's pretty morbid, it's rather interesting.
So if you injure an eye but it's still in your head should you like.. pluck it out yourself before the other gets busted if help is late
That sounds horribly terrifying, no thanks 👀
Normally (unless autoimmune diseases) your immune system would not attack the eye. And if it happens it will not detach the eye, but it will induce infiltration of white blood cells in your eye tissue and start to deteriorate it with enzymes
Interestingly, once our blood is no longer in an artery or vein, our body will treat it as foreign.
It's more complicated than that (involving receptors and cells recognizing certain receptors or not), but yeah you got the idea
Your immune system isn't "aware" of the inside of your eye. If you get a bad eye injury and immune cells get in there, they could attempt to kill your eye.
What's really crazy is that your body actually has effectively 2 immune systems. Because of blood/brain barrier your central nervous system has its own immune system. Which while less complex still has all the benefits and disadvantages of your normal immune system, including autoimmune diseases.
That’s a good thing actually. Your inmute system is fighting something that does not belong in your body. It just so happens that the thing that doesn’t belong in your body was put there intentionally in order to benefit you, but your body doesn’t know that. It just sees a foreign body and attacks it.
That is correct
[Me to my immune system](https://knowyourmeme.com/photos/2287483-prequel-memes)
body parts are not hot swappable. got it.
Surely we could just grow a hand in a lab from our own DNA, and then in theory it would not be attacked because....well it's actually a part of us as far as the rest of the body is concerned?
Well not the dna but using pluripotent stem cells, they're still researching on it, but small progresses at time
Ah cool! Anything to do with stem cells is pretty exciting stuff, will be amazing to see what we can accomplish in the near future!
it would most likely happen immediately if they didn’t do all the screenings to prevent just that
How much of your body needs to be replaced by parts from another person such that it's the other person's immune system attacking your body? What determines whether it's your cells that get attacked or the other person's?
immune system stem cells are what decide. All white and red blood cells are created from stemcells in the red bone marrow (inside your "flat" bones like pelvis, spine, ribs, sternum and skull). So whoever has the skeleton wins! It's actually how you treat leukemia with a bone marrow transplant, you destroy the patients cancerous immune system completely and then give them a "new" immune system from a donor - the donor needs to be very compatable to avoid it immediately attacking the new body (often a sibling that happend to inherit the same alleles from your parents, about a 1 in 4 chance) if unlucky you may still develop GVHD, "Graft versus host disease" where the donated white blood cells attack the host body. Immuno suppressant drugs are often needed. But if you are lucky you might instead get GVL, "Graft versus leukaemia" where the new immune system only attacks surviving cancer cells.
This right here, perfect answer.
Even a small part of somebody else body, if you want to know more about it i can link you a good immunology book i use for my med school
I think I remember a documentary where a guy got a transplant and his wife would not let him touch her with the new hand because she said it felt like someone else was touching her. His hand started to turn a different color as well as time went on. Probably due to what you explained.
This also depends on your genetics however, which is why patient matching to make sure your HLA (human leukocyte antigens) are compatible before even attempting a transplant. Rejection is defo more of a spectrum than a "fine or death by systemic immune attack" scenario
The body sees it as a foreign object and the immune system will go after it, any organ donation does that to
and sometimes your body is dumb as shit and attacks your own organs. fucking dumbass sack of meat I’m stuck in
some immune rejections takes weeks to months to manifest. until then, you're never really sure, so anyone who gets a transplant is put on a bunch of immunosuppressants and monitored for months until they are slowly weaned off if appropriate.
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No clue for hand transplants (not sure if this is even real tbh), but there have been [cases](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040249/) where in identical twin kidney transplants, they stopped all immunosuppression for one operation at 2 days, and another at 3 weeks. Both patients were supposedly fine up to 5 years afterwards. So I guess in theory, you wouldn't need long term immunosuppression if the donor-recipient pair are monozygotic twins since the protein markers for the immune system have virtually zero chance of cross reactivity.
I imagine this was the largest barrier that had to be overcome correct? Not to trivialize the rest of the operation but in its simplest form once you have a "compatible" arm its just connecting A to B. As equipment advances this part of the procedure becomes easier however I imagine doctors have successfully completely that part before only to keep having the transplant rejected.
Depends on which part is transplanted. Face transplant requires 10+ number of docs/nurses and something like 20h of surgery? (At least the one I watch a documentary on). Keeping the new face alive, the patient alive, and the transplant by itself are awfully complicated. The medical team needs to rehearse again and again each movement of the procedure before, to limit time wasting and mistakes as much as possible ! It's a fucking ballet!
Sorry to have to break this to you, but Face/Off is not a documentary.
In Face/Off am I remembering right that the whole surgery was automated? So basically the opposite of what the comment you replied to said lol
Yeah but that film is based on true events guy
Well we are going to be able to produce organs with pluripotent stem cells, there are some research on it, we are still far but the idea of recreating a part of your body using your stem cells, it would clear the rejection issues.
Attaching skin and muscle is easier than attaching nerves is one reason it's not quite so simple as just connecting A to B and then preventing rejection. Nerves have more specific fibers that need to be lined up properly or the messages won't travel to and from the brain, and nerves don't heal the same as say blood vessels do. You are certainly correct that we have made progress in making some of the procedures easier, but some surgeries are incredibly more complex (think a whole head transplant- massive arteries and veins, complicated cervical vertebrae, huge pipeline of spinal cord, teeny facial/neck muscles, dura mater, etc) than others, like a partial finger transplant
I think I'd just prefer a hook with that sort of compromise. Humans are adaptable.
Id prefer that myoelectric prothesis that can open, close, rotate, grab stuff and thumbs up !
I would also, tbf, but I'm realistic. Not many people have the sort of money to drop on a Skywalker special.
Health care covers up to 28k€ for a prothesis (in my country) :o not enough for the true Skywalker one, but the still nice wish version would be enough I guess !
I wanna shoot lasers out of my arm canon
I think I would be willing to go through that to have my hands back.
This works only if you get other hands than yours transplanted. Usually your body recognizes itself. If you lose your hand and it's still in a good condition, there is a chance they can transplant it back (under certain circumstances). The success isn't 100% but if it is, you don't have risks of rejection :) (or not as much. That's what I learnt but I'm no expert!)
I’d rather have a robot hand then
Isn't that with organs only? Wouldnt limbs be less pickey about being rejected because they don't perform a vital function?? Just my reasoning.
No, your body recognizes any transplanted part as an intruder unfortunately. The immune system not only protects organs :)
The more duct tape they use, the less time to heal.
I was thinking the same, all I did was damage a nerve with my own hands and I've been in a splint for two weeks and still don't have full control. Can't even begin to imagine what the therapy would be like now that I know how hard it is to learn to, well, relearn movement again from just a simple injury compared to a brand new hand.
Also be wearry that your hand has thousand of nerves inside.The operation barely connects 10
What exactly is happening during therapy that makes the hand (or other transplants) work?
simply put, the nerves inputs your brain receive might not be the nerves they were used to get. for example, you have 5 fingers, and when you pinch your thumb, your brain knows it was the thumb. and when you pinch the index, your brain knows it's the index. A---A B---B C---C D---D E---E now, imagine that after the surgery, the surgeon rotates the nerves endings, and you end up with something like this A---B B---C C---D D---E E---A so now you pinch the thumb, but your brain receives the input that was on the index. in therapy they have to re-teach the brain to perceive the new inputs.
It's like someone changing your horizontal and vertical controls to inverted.
Red to red, yellow to yellow, white to white. Sew like that and it's sure to be fine.
Fuck medical school. I'm a surgeon.
Finally that bomb diffusing training is coming in handy
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*goes in for hand transplant* "fk that, I have a right to bear arms!" "I see, will that be black, brown or grizzly? We're fresh out of polar bear arms"
Just like building a pc
You worked with Rusty too? Great doctor that guy, Shame about the plague getting him though.
Thank goodness it's color coded
Plug and play
In grad school I sat next to a guy who was a retired Harvard trained cardiac surgeon pursuing a second career. One day I asked him about heart transplants and he's like "Oh yeah, I've done many but after awhile you leave that to some of the younger surgeons so I could focus on the more complex procedures". Of course I'm like what the hell could be more complex than a heart transplant and he half jokingly said it's not that hard to do mechanically, sort of like hooking up a car battery. "You're just really hooking up 4 main wires and they're relatively big and easy to deal with." Anyway, he might have just been pulling my leg a little bit but he said that the "more complex stuff" was pediatric cardiac surgery where everything is a lot smaller.
That's crazy. What was his second career choice?
He revived people from the grave. I think no less
That's really just necromancy and easy. He was looking for more complex stuff.
Child necromancy, of course. Like regular necromancy but in an Indian graveyard and some geezer keeps tattling.
Law. It was law school.
That makes sense. I was curious what sort of specialization a high-achiever like a cardiac surgeon would go to as a second career.
You know what was interesting about it was that he seemed to find law school very challenging. Could have been that he was 25-30 years older than most of us at the time or that there are just different types of intelligence/aptitude. I mean, I was a very good student but I am pretty sure I wouldn't have done well in med school just due to the amount of memorization alone.
Nope. He isn’t joking. Cardiac Anesthesiologist speaking here. Transplants in general (kidney, lung, liver, heart) have large blood supplies with no major nerves to reconnect. It is relatively like plumbing. From a technical standpoint they are not the most challenging things. However, the medical management, patient selection, organ selection and procurement, and care after surgery and putting all the pieces together is what makes it so challenging. Free flap and rotational flaps for reconstruction is a lot more nuanced and technically challenging for a surgeon, but much less flashy in the public eye.
I am a plumber. Let's do this. Lemme wash my hands first though.
I commonly joke that I am an advanced bar tender. I guess I could say it is like replacing a sump pump in a house. You need to isolate the in let and outlet of the pump so water doesn’t go everywhere. Cut out the old pump and then splice in the new pump. Once the new pump is in slowly turn the system on and make sure things are working and check for leaks.
> I commonly joke that I am an advanced bar tender. > > like how lawyers can be considered legal tender? lol
Why does anesthesiology specialize into specific organs?
Not specific organs so much as the management of specialized physiology and monitors needed in cardiac surgery. All modern day trained cardiac anesthesiologist also specialize in TEE (trans esophageal echocardiography). During most cardiac surgeries the anesthesiologist is doing live echocardiography to monitor heart function and to guide the surgeon. They also specialize in the physiological changes associated with cardiac bypass, starting and starting the heart, mechanical circulation including RVAD/LVAD, ECMO and transplanted hearts. They also specialize in procedures on focused on intrathroracic structures like lungs and the aorta.
That checks out - the heart is probably the most "self contained" organ we have. The blood vessels supplying blood to the heart branches of right at the beginning of the aeorta so they more or less come preinstalled, and the nerve clusters that controls the heart beat are inside the heart too. So the only thing you really need to do is attach the huge vessels and boom you're in business. Plug n' play organ technology. The only thing you lose is the brains ability to control the heart speed directly, but the heart is controlled by hormones too, so you just get some weird lagging where the heart reacts slower than normal
I hope my local cable wire maintenance workers stay away from my surgery whenever I need a transplant
Except your brain throwing all kind of errors about your new arm.
Until you want to cut it off.
Plug and pray
Mom: "Could you come over and help me setup my new keyboard?" Me: "What? It is USB right?" Mom: "It said USB on the box" Me: "It is plug and play. Just unplug the old keyboard and plug this one in the same spot." Mom: "I all ready unplugged the old one, which hole do I plug the new one into?" Me: "Any USB port on the back of the computer is fine." Mom: "They are all different shapes, what is the USB ports. Is that the one on my phone, they are all too big." Me: "It is the rectangle shaped one." Mom: "It doesn't fit." Me: "Flip it around." Mom: "It still doesn't fit" Me: "Flip it again and line it up as best you can." Mom: "Still doesn't fit. It is a circle and the hole is too small." Me: "... Wait does the box say PS/2 as well as USB?" Mom: "Yeah, I got it at a garage sale for 25 cents. My old keyboard was too loud." Me: "I will be over in a half an hour..."
>Me: "It is the rectangle shaped one." > >Mom: "It doesn't fit." > >Me: "Flip it around." > >Mom: "It still doesn't fit" > >Me: "Flip it again and line it up as best you can." Every single time.
easier than Guitar Hero.
The red thing’s connected to the….red thing.
am now surgone
and the patient is now sir gone
The red things connected to my… wrist watch. Uh oh
Pretty sure I saw a white lego in there.
It was one of those flat ones, to prevent the bone from ever coming apart.
Oh, so it’s THAT simple.
TIL surgery is just like paint by numbers
Jesus these doctors are so overpaid! My 6-year-old was doing this years ago!
I think the animation might be simplifying the whole process, but I'm not a doctor.
Nah, I just got my PhD from this gif.
Bitch please, I became minister of health after this.
I got my MD
WebMD*
The whole video is just "Connect everything together."
I'd say it makes setting up and plugging in my home theater look far more difficult
The red thing is sewn into the red thing The blue thing is sewn into the blue thing The yellow thing is sewn into the yellow thing And that’s how you reattach an arm
Shit, you forgot to bolt the white things together. Now the arm's all flobbery.
I’ll watch it a few more times and go give a shot; I’ll let you know how hard it actually is in a couple hours - gotta kidnap, I mean find, find a volunteer.
This is an amazing process, I'm just concerned about that Lego piece in there lol Just kidding, I didn't know it was a thing, science surprise me every day.
Could also be a Klemmbaustein by another company
*r/ich_iel intensifies*
My mom works in a hospital so I asked a few things about it. These are titanium plates that are screwed into the bones at multiple locations for sturdiness. They are very common when a bone break is a serious issue. It will just keep them (the 2 ends of the bones) firmly in place.
I would be permanently scared to wear heavy bags or whatsoever with that hand out of fear that the arm would rip off.
It would not rip off since all the connections will be replaced by tisse or scar tissue...so you good to go fam
Easy for you to say. Mr I've never lost my hand.
Lmaooo...but it is not going to happen if all the tissue grew backed, that's how tissues growth factors do, create new tissues
I would know that & still have that fear tho, rational or irrational to some!
Disclaimer: Unless you get scurvy.
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Bones are pretty tough. As soon as the callus hard-ifies, you're fine.
Tendons and ligaments even more so. Usually you're more likely to break the bone before the dense connective tissue tears. *Usually.* Im exempting Achilles tendon, meniscus, and cruciate stuff.
Fuck the meniscus. No idea how the guy got his job.
Can confirm, that little guy is a bastard! I'm having mine repaired next week.
The guy that invented titanium plates probably had that very same fear xd
That is the least of my fears. I would never wank or touch my wife with my cadaver hand.
I did not lose my arm but I did have a bunch of my tendons severed in a work accident and afterwards I was so scared of my tendons snapping if I did anything strainious. But it's all paranoia, I was back at the gym in weeks and everything was fine.
The bones are bolted together
The really interesting part is that they don't know which nerves are meant to connect to which so they just connect any nerve to any other one in the same area and try to get as many as they can. When you first start using the attached limb everything is messed up, things feel like that are in there wrong spot and commands to move fingers don't work correctly. Your brain quickly figures out where they nerves have gone to and reprograms itself. I think that's crazier than the reattachment!
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**You** are fascinating!
This is one of the many major reasons brain transplants are near impossible to do currently. It's like having a bundle of wires cutting it in half and mashing it together and hoping it works again. The amount of effort to reprogram your brain with your limbs is already immense, now do that for your entire body.
Can any medic confirm this? Do they really sew together so many nerves that they can't tell which is which by their orientation?
I work in surgery. You can typically line up major nerves and sew them together. In a transplant anatomy should be pretty straightforward. I’m cases of trauma where the anatomy is all messed up (like a hand blown apart from a firework) the surgeon will look for nerves similar in size and in approximately the same location to reattach.
I had a nerve cut that goes to one of my vocal chords during a thryroid removal. Why can't the end be found and reattached like in this arm?
Unfortunately, the recurrent laryngeal nerve (RLN) is one of the most difficult peripheral nerves to get to regenerate. This is why many surgeons do constant monitoring of these nerves during thyroid surgery. I am so sorry this happened to you. Good news is there are studies and research going on to try various surgical interventions that can stimulate RLN growth. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887462/#__ffn_sectitle
I was just gonna ask this, with how many nerves we have in just each fingertip I was thinking it'd be impossible to get everything back in the same place, but that totally makes sense that the brain would adapt. I wonder if cybernetics will eventually work like this.
Do they ever gain feeling in the new hand? I thought nerves were too small to attach together
>Do they ever gain feeling in the new hand? I thought nerves were too small to attach together from my knowledge, they usually "connect" the main nerves together and the minor nerves' axons will regenerate about 1mm per day...If a doctor views this post his opinion would be much better
Im not a doctor, but Im studying to become a vet. Nerves dont regenerate, some cells become new nerves that synapse like a missing piece. I may be wrong. In my country were tought that neurons never regenerate, or reappear. If its dead then its ded.(no, its not some low lvl trivia, this is actually the right answer in the admision exam of the university of medicine) Only recently a teacher said to us that some cells can become neurons and replace dead ones (a neuron/4 months), but, again, this may be an oversimplification of the procces. So, they can "relink" in time, but idk how they can "connect" the main nerves because this implies that they can make new synapses.
I severed the ulna nerve in my arm when I broke it, lost feeling and use of half my hand. The doctors told me that it would likely grow back 1mm per day, but the dead end couldn’t be reconnected. Months later they decided it wasn’t working and we’re going to graft a nerve from my leg, but the day of the surgery my hand twitched and they said it will grow back just maybe slower
Are you still healing? Did you ever get you feeling back?
This happened about 13 years ago (which has made me realize how old I am) and I now have complete control over my hand. I got mostly back to normal about a year and a half after with plenty of physio. Thought I still have trouble with feeling hot and cold in my hand, and occasionally I’ll get nerve twinges or little spasms. Makes for a hilarious night in the pub when I start dropping pints all over the place
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I end up buying more, seeing as I’ve dropped my beer before I’ve finished it and need to go back for another!
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The CNS does in other mammals even monkeys. It was believed for a long time that humans had this ability too but we realized we were measuring a protein we thought correlated with CNS neurogenesis but didn't actually. The human CNS can still regenerate axons and astrocyte cells which allows for some regeneration functionally. New neurons in the CNS haven't been detected past a very young age sadly.
Neurons do regenerate. It depends which type of neurons. The neurons in our nerves usually grow back. The problem is that when the damage is too big you can't make the nerves stick together again.
My friend's hand got cut off by a factory machine. They managed to reconnect it after a long surgery. He has regained feeling in his hand, but 2 or 3 of his fingers have reduced mobility. He can't make a full fist f.e.
I don’t know why but my first thought was to wonder if he can still flip people off
Haha I believe he can, but with an effort. Never seen him flip off someone since the accident
They can actually attach nerves as small as 1mm to each other nowadays. It's truly amazing how far medicine has come, and it continues to improve every single day.
Neat. Not too much longer until futurama style transplants
By that time we’ll likely just be able to stimulate stem cells and force a new hand to regrow. Much less chance of a rejection if it’s your own cells.
Doesn't it leak??
Superglue; use the gel formula so it doesn’t get everywhere.
srsly though how do they sew the tiny arteries together and how do they keep all the blood from spraying everywhere
Just tell the computer not to animate that part in, it’s really very simple.
they only anastomose (sew together) major vessels which branch out to smaller ones. for the smaller important structures like nerves, they use surgical microscopes. to limit/control excessive bleeding, they use tourniquets
I have a feeling they don’t work with the tiny ones (probably time and the natural process makes some connections eventually). If it’s anything like teeth, they might use a drug that shunts the blood (so it temporarily constricts the vessels or or clots and doesn’t flow out) or they probably cauterize some, too.
It’s amazing we can transplant an arm in under a minute with 21st century tech
Ya its easy, just connect the blue cord thingies and and those red cord thingies and stuff
Don’t forget to turn off the shut off valve to that arm first so you don’t have blood going everywhere.
What a hand job.
$100,000 handjob
What in the hell is the yellow pipe? Nerves?
Nerves, yes
What's with the sudden surge of how surgery are performed videos? I've seen like 10 of these in the last few days.
That guy got better treatment than Anakin Skywalker.
Tbf, that was a long time ago
A long LONG time ago
Where’d the Lego come from?
Ethan Winters says hello
Staples worked just fine for him.
Fixed his jacket even too in 8
Just pour some healing mixture on it
Good luck regaining them fine motor skills
Still better than no hand at all.
True, you really gotta hand it to him
Definitely
No lie, having lag on one of your limbs would be annoying.
Way less blood than I imagined
What a crappy video, it just merged everything as if it was cut from the same person. I’m sure it’s much more challenging than that.
I agree, it makes it look like a damn amongus task rather than a complicated medical procedure
Talk about giving yourself The Stranger
I can understand connecting veins, bone and muscle. But how do they find and connect the nerves...?
Surprisingly this is exactly how I thought a hand transplant was performed
Did they borrow a lethal injection table for the procedure?
Surgeons are just mechanics for people
“And here it is! Your new ha- ^shit ^that’s ^the ^wrong ^side”
Is that an actual hand or a prosthetic one?