---
title: 'Hand Transplantation - Vascularized Composite Allotransplantation'
type: 'lecture'
url: 'https://doc.social/lectures/hand-transplantation-vascularized-composite-allotransplantation'
published: '2021-04-01'
author: 'alidad ghiassi'
transcript: 'yes'
---

# Hand Transplantation - Vascularized Composite Allotransplantation

Dr. Alidad Ghiassi presents a lecture on Hand Transplantation to the Doc Social OSIG.

## Summary

Dr. Alidad Ghiassi presents a lecture on Hand Transplantation to the [Medical Student Orthopedic Surgery Interest Group (OSIG)](https://doc.social/groups/medical-student-orthopedic-surgery-interest-group-osig/)

## Transcript

4,607 words · 31 min · 2 speakers · automatically transcribed (aws-transcribe) and not checked by a person; it may contain errors, particularly in names, drugs and dosages. The recording is the source.

[0:00] Speaker 1: In full screen mode there, right? Yes sir. So I can't see you guys, but I can see my screen, and then um please uh chime in when you have questions, OK? Cause I like the interaction.
[0:15] Speaker 1: Pause me.
[0:18] Speaker 1: Um, you know, I was thinking of what, what to talk about, you know, like, I can tell you what a hand surgeon does, what I've done, you know, what I'm currently doing. But then I thought, well, you know, why don't I show you some cool things about hand Surgery.
[0:33] Speaker 1: And um talk about Hand transplantation.
[0:38] Speaker 1: Um, cause that's kind of an uncommon thing, and it involves a lot of different disciplines.
[0:43] Speaker 1: Not just Surgery, but, you know, psychology, you know, it's ethics, you name it, it's all combined into this one procedure.
[0:53] Speaker 1: Um, another name for it is vascularized composite alloy transplantation.
[0:58] Speaker 1: Which really, uh, you know,
[1:01] Speaker 1: Is out there as far as being the cutting edge kind of work you can do in hand Surgery.
[1:06] Speaker 1: And one of the reasons I, I am, I, I got interested in hand in hand Surgery is the fact that you can do complex things like this, or you can do simple office-based procedures, and the main thing that you do need is just knowledge of the anatomy.
[1:23] Speaker 1: Um, and it's it's with a simple set of tools, you can do a lot. Now, you can't do hand transplants, but you can do a ton. So anyone gets dropped off in any part of the world and they're a hand surgeon, they can do a lot of good with the bala xylocaine and, you know, some simple surgical tools and maybe some betadine, but you can get a lot done. Um, so this kind of sums it up. Hand transplantation really sums all that up.
[1:49] Speaker 1: Uh, have this slide up because, uh, you know, to kind of know where you are, you gotta know where you came from, at least a little bit.
[1:56] Speaker 1: You know, um, that gives you a kind of a roadmap and context as to
[2:02] Speaker 1: Where you're gonna go as well.
[2:04] Speaker 1: And this doctor here name is Joseph H. Boys, and he's one of the founders for the field of hand Surgery after the Second War. He was a general surgeon by training, but after the war there's so many devastating hand injuries in young men.
[2:20] Speaker 1: He really dedicated his life to treating them, and really started um the field of hand Surgery in the 50s and 60s, and the USC Hand Fellowship is actually named after him, and it's endowed by his foundation as well. So,
[2:39] Speaker 1: Um,
[2:41] Speaker 1: He's really the original, original hand surgeon.
[2:45] Speaker 1: And why is the hand so important, you know, when you're looking at it, you know, I mean, I, I can't tell you how many times that people say what you do. I say I'm a hand surgeon. They say, oh, I'm a small finger surgeon, or I'm an earlobe surgeon. But I mean, until you get a hand injury, you don't realize how important your hand is. And if you look at it, it is really the end organ that connects us to the world.
[3:06] Speaker 1: So without our hands we can't really do anything, and there's a, there's a large number of people out there who believe that the development of the
[3:14] Speaker 1: The modern human brain correlates with the development of the opposable thumb and the hand.
[3:20] Speaker 1: And there is truth to that, somewhat. We don't know which came first, but
[3:25] Speaker 1: Really, if you look at the cerebral cortex, the face is the most highly represented body part, and after that is the, and the homunculus is the is the human hand. It's really your hands that connect you to the to the outside world, and you can do everything with it, you know, you can manipulate the world, you can talk with it, you can read with it. You can really tell people what you think, right? When you're really upset, um, and
[3:54] Speaker 1: You know, you can tell people how you feel, right? I mean, you touch someone on a, you know, in a certain way, they know exactly what you mean. So it conveys a ton of information, and it's not just another body positioner, it's a sensory end organ that manipulates the whole environment. And that's really important to understand, cause, you know, unlike the foot, you know, you, you lose a foot, you can still do a lot, but you lose a hand and the whole world changes.
[4:20] Speaker 1: That's why people are trying to solve this whole issue of uh loss of the hand.
[4:25] Speaker 1: And Upper Extremity amputations are, you know, they're, they're common. They're not as common as lower extremity, but you get patients losing their arms from trauma, infections, congenital conditions, uh, or vascular disease, and it does have a profound, um, physical and psychological effect on the, on the human.
[4:46] Speaker 1: It's a photo of someone who had a mangled extremity, probably for forklift injury, that's not salvageable, and these are the kind of people, especially if they're young, um, to really benefit from this type of uh Technology.
[5:02] Speaker 1: So what do you normally do, right? You know, you lose a hand. Well, there's options or prosthetic options, um, but they all have drawbacks. So you have the hook, which really, um,
[5:13] Speaker 1: I basically mechanically oriented um.
[5:17] Speaker 1: Set of metal and rubber bands that you manipulate to open and close.
[5:23] Speaker 1: Um, but it doesn't really get your hand function. It gives you more of an assistive function, so you can, you can get by.
[5:30] Speaker 1: You can get a cosmetic hand, which is on the lower um left here. And this is more for, you know, social situations where you don't wanna be seen without a hand, but it just doesn't provide any function.
[5:43] Speaker 1: Um, or you can get a myoelectric prosthesis here where, you know, the signals from the muscle or the nerve connecting to the muscle can power the electronics on the myoelectric. That works pretty well, but it's got some issues, right? It's heavy, expensive, needs batteries to run, and certainly doesn't give you sensory feedback, so you really don't know how hard you're squeezing on something.
[6:11] Speaker 1: And for a lot of patients, it's just compliance is an issue. They'd rather just get on with it. Maybe put a hook prosthesis or cosmetic prosthesis as opposed to more cumbersome myoelectric prosthesis.
[6:23] Speaker 1: So really, at best that we've done so far with replacements is prosthesis and at best, um, you know, something that can work but needs a lot of attention.
[6:35] Speaker 1: So, and then the concept of hand transplation plantation comes into play.
[6:40] Speaker 1: And this is where you're really replacing like with like.
[6:43] Speaker 1: Uh, to improve dexterity, sensation, proprioception.
[6:47] Speaker 1: And also um improve the patient's overall um psychological appearance.
[6:54] Speaker 1: Sorry for the misspelling at the bottom, but the downside of doing this kind of procedure.
[6:59] Speaker 1: is really the immune suppression that goes with it.
[7:03] Speaker 1: Um, and you'll find out more as we talk more. So you can see this patient here.
[7:09] Speaker 1: You know, one way of eating is another way of eating, and
[7:13] Speaker 1: Certainly though, to me the picture on the right seems more
[7:18] Speaker 1: More enjoyable.
[7:20] Speaker 1: So Hand transplantation really is the combination of hand Surgery and solid organ transplantation.
[7:27] Speaker 1: And um if you're wondering how you become a hand surgeon, well, there's several ways. You can be an orthopedic surgeon, a plastic surgeon, or a general Surgery microsurgeon. That all gets you to hand Surgery.
[7:41] Speaker 1: Then solid organ transplantation is really um a different, different field altogether, cause
[7:49] Speaker 1: What they do is transplant organs, but it's the immune suppressive therapies, the multidisciplinary Approach, the complex um care coordination and aftercare pathways that are really important in solid organ transplantation. Um, the technical aspects of it, even though they're important, you know, once you put that organ in, hook it up, then it does its thing.
[8:13] Speaker 1: You know, it's not, you don't have to get it to.
[8:16] Speaker 1: Have nerve regeneration or manipulate or have function.
[8:20] Speaker 1: for that 2 hours that you're putting it in is the critical part, and the rest of it becomes the aftercare. And Hand transplantation really is the combination of um
[8:31] Speaker 1: Combination of the two fields where we took the knowledge base from solid organ transplantation and from hand Surgery and um you know, worked on getting a hand transplant.
[8:46] Speaker 1: And the first one was really done in the 60s.
[8:49] Speaker 1: Um, you know, uh, it was done, I think, in South America, and it lasted at best 3 weeks until the hand got rejected. And the main reason was that the immune suppressant, uh, modalities were not there.
[9:04] Speaker 1: So, um, that experiment was a failed experiment, but it was a thought.
[9:11] Speaker 1: It's really till 3 decades later when people start pursuing this more.
[9:16] Speaker 1: Um, and the reason for the difficulty in trying to get control over the immune suppression is the skin and the lymphatics. They're very immunogenic, and it's really, it was really difficult to try to figure out how to prevent rejection.
[9:32] Speaker 1: But, you know, through some science experiments and more experience, um, it did take another 3 decades in order to be able to, um, to do this, uh, to really revisit this uh procedure all over again.
[9:48] Speaker 1: And uh 1998 was a second attempt at Hand transplantation in France.
[9:56] Speaker 1: And the donor was a 41 year old man who had a head injury, and the recipient was a forty-eight-year-old businessman who had lost his hand in a sketle saw accident.
[10:08] Speaker 1: Um, he had working muscles. He had strong motivation to, to have the procedure done. He even had a psychological evaluation.
[10:16] Speaker 1: And since it was technically feasible, they selected him to get a hand transplant.
[10:23] Speaker 1: So what do you guys think happened next?
[10:26] Speaker 1: Anyone chime in.
[10:31] Speaker 1: Don't be shy.
[10:37] Speaker 1: Shay, you wanna chime in? What do you think happened?
[10:41] Speaker 2: Well, I'm imagining it would be probably a little bit better since it wasn't a cadaver hand and it was from a live donor, but I'm probably wrong, I guess.
[10:50] Speaker 1: No, there's no, I tell you, man, there's no wrong answers, you know, there's only good answers and better answers in my mind.
[10:58] Speaker 1: It's on there, yeah.
[11:02] Speaker 1: Anyway, um,
[11:04] Speaker 1: He lost a hand
[11:06] Speaker 1: Um, it turns out he was actually a prisoner from New Zealand, uh, who lost his hand in the, this is, by the way, you know, pre, uh, pre-social media, so who knows, right? He lost his hand and he failed to take his post-op, uh, uh, medicines, and he rejected the hand, um, because of that, and he wound up actually at the front doorsteps of USC LAC Hospital.
[11:33] Speaker 1: Where he had requested the mummified hand to be taken off, but there was so much media attention at this point that I think the hospital didn't want to deal with it, so they put him on a plane and sent him back to France to get it removed.
[11:45] Speaker 1: Um, the interesting part of this is that the actual doctor who did this was interviewed, and I'm gonna play the interview.
[11:53] Speaker 1: Can you guys hear that or
[11:54] Speaker 2: no?
[11:58] Speaker 2: No, sir.
[12:05] Speaker 1: Can you hear it?
[12:09] Speaker 2: No, we can't. I'm wondering.
[12:13] Speaker 1: Well, I'll just tell you what's happening here. So he's actually, this is the original interview of the patient with the physician.
[12:21] Speaker 1: The physician is the bearded guy on the right, and there's the patient after the transplant, and it's a little bit of a promo fluff piece. Um, then, you know, they're asking the doctor.
[12:33] Speaker 1: What made him lose the hand?
[12:37] Speaker 1: And he kind of doesn't say exactly, kind of says a little bit, and doesn't really say it. He says maybe financial or this.
[12:46] Speaker 1: But the real reason is that it was just poor, poor Patient Selection. I mean, they just picked the wrong person for this procedure. And um it's never the patient's fault in my mind, you know, I mean, we get this into this in Medicine all the time. You know, you did this because it's your fault, but ultimately, the physicians, I think, are responsible.
[13:05] Speaker 1: So, he kind of sugarcoated the interview saying, oh, maybe he should have taken his meds, but yeah, maybe you should have picked better as your first candidate for this uh procedure.
[13:16] Speaker 1: But that didn't stop us because moving forward, you know, a year later, the first hand transplant was performed in the US and at the time I did this lecture, it was the longest surviving hand transplant, uh, known, and it really set the ball rolling. Uh, By the way, Louisville is a very famous hand Surgery center as well. That's where they did it. Um.
[13:40] Speaker 1: And there's even more data to support that these transplants can survive if you are able to pick the right patient and um give them the right uh support with immune suppression, um, and they, you really get reasonable function, even though they have some challenges with um rejections.
[14:01] Speaker 1: So really the question is, you know, who do you do this on? Is it worth it?
[14:07] Speaker 1: Um, you know, it's not life-threatening. It's, you know, life enhancing, and there are some drawbacks from the immune suppression such as, you know, uh, avascular necrosis, diabetes, high blood pressure, and, um, that dilemma hasn't been fully sorted out.
[14:27] Speaker 1: Um, we also, you know, moved ahead and did bilateral hand transplants, and that's another one, where, you know, instead of one, you do two hand transplants at the same time. That takes about 20 surgeons to do two hand transplants all in the same setting on one body. As a matter of fact, uh, this is a pediatric patient. I got, I think a hand, got 2 hands transplanted, and also a kidney transplant.
[14:53] Speaker 1: And to me, that kind of makes sense cause, you know, the picture on the left here, poor kid playing with little, you know, um, rings and not having a real good interaction there, and then he gets a hand and he gets to play with his, uh, with his toys, and he's getting the kidney, um, as well, so the immune suppression is not as, uh, difficult to digest cause he needs the kidney in order to, to not get dialyzed all the time.
[15:20] Speaker 1: And we moved on from there. It really took off. They did a face transplant.
[15:24] Speaker 1: This guy's actually had two face transplants. Imagine that, right? I mean, that's what he looked like. I think his face, I forget what it was, the injury, but a horrible looking.
[15:34] Speaker 1: Accident with, you know, they did some reconstruction of his chin and nose, but then this is what it looks like after the transplant.
[15:42] Speaker 1: Um, and I think he wound up with another one after this cause of some rejection issues, but
[15:47] Speaker 1: And this is stuff of science fiction we could get a face transplanted.
[15:51] Speaker 1: And this guy is the first penile transplant.
[15:55] Speaker 1: Um, yeah, and he's pretty happy.
[15:58] Speaker 1: And he is actually functional. I think he even bore children.
[16:02] Speaker 1: Um, and then we went on from there to do uterine transplants. So really it opened up the whole Pandora's box with, you know, composite, uh, tissue transplantation.
[16:14] Speaker 1: Um, and we might have even gone too far because, you know, these are the places that have had, at least when I checked this last, have had experience with Hand transplantation.
[16:25] Speaker 1: Um, and the function seems to be reasonable for the most part, but we may be overdoing it. Now, I'm gonna play this video. This is our patient.
[16:34] Speaker 1: Can you hear that?
[16:41] Speaker 1: Can you guys hear that? We can't, we can't, we can't hear it.
[16:45] Speaker 1: Yes or no? Yes, you can. No, no, we can't.
[16:49] Speaker 1: What a bummer. OK, so I will play it anyways. I don't know why it's not, I can hear.
[16:57] Speaker 1: So this is his daughter, and this is after the transplant.
[17:01] Speaker 1: He's looking away, asking Ariana to put a hot or cold bottle of water in his hand.
[17:12] Speaker 1: He says this is room temperature water.
[17:15] Speaker 1: And then she mixes it up again.
[17:19] Speaker 1: This is really critical cause the sensation is the hardest thing to achieve, and she tricks him again by putting the warm water back in there.
[17:27] Speaker 1: Temperature.
[17:28] Speaker 1: And she's having a field day.
[17:33] Speaker 1: Go.
[17:43] Speaker 1: So that's the amazing part of it, you know, being able to
[17:46] Speaker 1: Get sensory recovery, and he's, you know, used it for all sorts of activities.
[17:53] Speaker 1: So, you know, when you're looking at this, um,
[17:57] Speaker 1: There's lots of issues, right? I mean, solid organ, there's, it's life saving and Hand transplantation. It's improved quality of life, and really the autonomy of the patient is really important to respect and not to try to push him into this situation, because it could be a bad decision as well.
[18:15] Speaker 1: So really my dilemma was in, I guess back in 2014, I was approached by the hand surgeons at UCLA to join them, to do a combined hand and liver transplant on a patient who had lost her hand because of an IV infiltration infection, and she also had congenital liver disease, and was also mute, so she used her hands to communicate.
[18:40] Speaker 1: Or sign language
[18:41] Speaker 1: Um, so I thought, hey, you know, I mean, we're gonna do good cause she needs a liver, she's gonna get immune suppressed and we can even give her the ability to communicate.
[18:51] Speaker 1: So I joined the team. We did some surgical rehearsals cause you can't, this is not one of those Operations you can just walk into. You got to rehearse multiple times.
[18:59] Speaker 1: It was not easy because, you know, the liver is on the right side as well, so is the hand, the tight space, a lot of
[19:05] Speaker 1: Big egos in the room, everyone wanting to get their space and do their thing, and
[19:11] Speaker 1: You know, when the timing is really critical as well, because, you know, you're putting your liver in.
[19:16] Speaker 1: Um, and doing the hand at the same time, and
[19:20] Speaker 1: It seemed to be something that we could do.
[19:23] Speaker 1: And her name came up on the list, and the Procurement team went down to procure the organ, but the hand had a tattoo on it. Now this is not the hand, but I just have that up there.
[19:35] Speaker 1: And the tattoo is an identifying marker, which according to IRB protocol, cannot be used for transplantation cause of patient uh privacy issues.
[19:47] Speaker 1: So she had a decision to make either a liver.
[19:50] Speaker 1: And no hand or just wait and potentially get sicker from her liver condition.
[19:57] Speaker 1: So what do you guys think she did?
[20:00] Speaker 1: What would you do?
[20:03] Speaker 1: Anyone.
[20:05] Speaker 1: Take the liver, wait for a hand.
[20:09] Speaker 1: You can't wait for a hand though, cause it's two different immune really.
[20:15] Speaker 1: Immune systems that you're dealing with, right? So the initial liver has a certain sort of, uh, you know, immune profile, and then if you take a hand, that's gonna have a different immune profile. So you're mixing and matching. So, so, it's a 11 time shop. Either take the liver, and that's it, you're never going to get a hand transplant.
[20:36] Speaker 1: Or take wait and take the liver in hand. And she did what exactly what you said is she took the liver cause life over limb, and uh she never got a transplant. So, that wasn't the first, that was uh when the launch pad, but never really launched.
[20:54] Speaker 1: And then fast forward to 2016.
[20:57] Speaker 1: This gentleman, Michael Coch, came up, and he was actually a TV producer, reality show producer in LA, totally normal guy, very successful, um, probably busier than he should be.
[21:11] Speaker 1: He was on a flight to, I believe, Maryland, when he's not feeling so well, goes to the ER and they say it's just the flu, gave him a shot of cortisone and maybe some antibiotics, and he went on the plane.
[21:23] Speaker 1: He goes to this meeting and the next thing he knows, he's in the ICU with a on ventilator, dying of multi-system organ failure.
[21:32] Speaker 1: He wound up getting this bizarre um immune condition that is most likely secondary to a viral infection that made all of his end organs fail. So when the body goes into organ failure, all the peripheral, um, organs wind up shutting down. They lose circulation, and you lose those body parts. And some of these patients will even lose nose, ears, kidneys, but he lost his right leg, entire right leg.
[22:00] Speaker 1: Part of his left foot, part of his right hand, and um his entire left hand.
[22:06] Speaker 1: So that's what the right side looked like. They did the removals at UCLA, so he flew back home after he survived the ICU experience.
[22:14] Speaker 1: And he had um removal of the tissue there. That's kind of what it looked like. On the left, it was uh almost the entire hand.
[22:24] Speaker 1: There's the uh median nerve, and um that's with everything removed.
[22:30] Speaker 1: And he was just left with that. Now, partial right hand, no left hand, no left leg, and a partial right foot.
[22:40] Speaker 1: So you can imagine during the morning.
[22:42] Speaker 1: When you need to go to the restroom.
[22:45] Speaker 1: How are you going to put on your prosthesis?
[22:48] Speaker 1: If you don't have a hand.
[22:51] Speaker 1: And
[22:52] Speaker 1: Who's gonna help you?
[22:54] Speaker 1: And if no one's there to help you, what are you gonna do? And if someone's gonna help you, how vulnerable are you? And every time you need to go to the restroom, you have to do, you have to rely on someone else. So you can see how it becomes um more than just the loss of a hand, it becomes just a huge, huge dysfunction.
[23:15] Speaker 1: And his whole life is affected by this, and this is a guy, he's a, I think he was from Pennsylvania originally, he's like a, you know, like a collegiate wrestler and just like one of these guys who is just unbelievable, and this happens to him on a Tuesday, right?
[23:31] Speaker 1: Without any warning.
[23:33] Speaker 1: So he was selected because he wanted to get this done and he went through extensive psychological testing, and he was found to be a good candidate for it.
[23:43] Speaker 1: And he was put on the transplant list, and his number came up.
[23:47] Speaker 1: And when it came up, the team went down to Orange County to procure the organ from the donor who was um 40 year old with a um a stroke, a vascular stroke.
[23:59] Speaker 1: And the organ seemed like it was gonna fit, and um when we heard that, the patient was brought back to the operating room. And I was just in my office at in uh down the street from UCLA.
[24:12] Speaker 1: And um was finished seeing my patients and just walked over to the hospital.
[24:17] Speaker 1: And we got started. Um, these markings here, by the way, are vein mappings because the veins are hard to find. So we mapped the veins while the patient is falling asleep to you know where they are.
[24:28] Speaker 1: And then this is what happens next. So you wind up having to dissect every single little vessel, nerve, tendon, muscle, and bone.
[24:40] Speaker 1: Is the radius.
[24:42] Speaker 1: Is the unknown.
[24:44] Speaker 1: And there's all the nerves, and you can see we tag every single little thing that you learn in your anatomy lesson, cause we gotta match it up to this.
[24:53] Speaker 1: So that's the donated um hand from Orange County with the vein magazine.
[24:58] Speaker 1: And you can see there's saline being run through here and it's on ice to keep the temperature down.
[25:04] Speaker 1: And um the same kind of a thing happens to the donor. So every single tiny little vessel, nerve, tendon gets marked.
[25:15] Speaker 1: You know, these are some of the things you see in your anatomy class, like palmaris longus and extensor carpi radialis longus.
[25:22] Speaker 1: Uh, median nerve, and then after that point,
[25:27] Speaker 1: We attached it to
[25:29] Speaker 1: So here you can see plates and screws being used to connect the bone.
[25:35] Speaker 1: Um, after that point, then we go ahead and start working on the tendons.
[25:40] Speaker 1: And we actually want to do the vessels as late as possible. As soon as you start bringing this thing to life, then you can't see anything. Your visualization is gone.
[25:52] Speaker 1: Um, because of all the bleeding, and the Surgery becomes extremely, extremely tedious, and it becomes very slow in pace. So you push as hard as you can to get as much as you can done within a certain amount of ischemic time, cause the clock's running, you know, there's tissue necrosis happening. And at some point, you let down the clamps on the blood vessels, and the hand comes alive.
[26:18] Speaker 1: And here it is, 11:12.
[26:21] Speaker 1: p.m.
[26:23] Speaker 1: That we just let the clamps down, the hand is nice and pink and profuse, and everyone's so excited, they said, Well, we're going to take our masks off. Now, this is pre-pandemic, so it was OK to take your masks off.
[26:35] Speaker 1: But um that's the whole team and everyone's got a role, and everyone understands their role. This is Doctor Azari Azari who's the, the lead um transplant surgeon.
[26:46] Speaker 1: These guys are orthopedic surgeons from the Kaiser Group down in Orange County.
[26:51] Speaker 1: Um, I'm there from USC. These are the microsurgeons, and this is the nurse anesthesiologist team, and there's our, um,
[27:00] Speaker 1: Um, there's our scrub tech who had no one help her take the mask off.
[27:06] Speaker 1: Um, and this is a brilliant moment because, you know, the hand was alive. Everyone took a sigh of relief and they said, OK, let's get back to the rest of it, which took till 6 in the morning, 67 in the morning the next day.
[27:19] Speaker 1: And here he is the next morning, first look.
[27:22] Speaker 1: And look at his face and look at his hand.
[27:32] Speaker 1: So he already has control.
[27:36] Speaker 1: Opening and closing his hand, even though he has that sensation.
[27:40] Speaker 1: And it's a very, very, very bizarre experience for him, but he wants to use it.
[27:50] Speaker 1: And then you got, you know, therapy afterwards in the hospital 5 days, and 2 weeks later, everything's starting to heal up.
[27:58] Speaker 1: And here he is at
[28:01] Speaker 1: 6 weeks.
[28:07] Speaker 1: And
[28:10] Speaker 1: Dribbling a basketball.
[28:17] Speaker 1: OK
[28:19] Speaker 1: And his X-rays are showing that this is him, you know, the bone is healed. This is where we did the connection between the bones, and it's already healed. These are the plates and screws. These are tiny little surgical clips there. But the thing is his, and as a matter of fact,
[28:34] Speaker 1: 3 months later,
[28:38] Speaker 1: He's doing that.
[28:43] Speaker 1: And
[28:44] Speaker 1: Doing this.
[28:51] Speaker 1: And doing this.
[28:59] Speaker 1: And this
[29:05] Speaker 1: Too bad you couldn't hear the sound on that, but it was the Rocky Balboa song in the background there where he's doing this too.
[29:13] Speaker 1: And tying his shoelaces, right?
[29:36] Speaker 1: And this, I can't even do this.
[29:49] Speaker 1: And this is an important position by this called intrinsic plus position. This tells you that the nerves have regrown, so he can actually do that. People who don't get nerve regeneration usually get a hand like that. So to be able to do this is unbelievable. He's running marathons and
[30:05] Speaker 1: Doing all sorts of things he likes, and even, you know, and doing some fine dexterity work like this.
[30:15] Speaker 1: And finally,
[30:17] Speaker 1: It's called a McConnell test, you know, this is how the therapist wind up figuring out how good you are.
[30:23] Speaker 1: Of what you're doing by
[30:25] Speaker 1: Doing certain tasks.
[31:05] Speaker 1: All right, so I'm gonna pause here cause that's all I gotta share with you.
[31:10] Speaker 1: And see if you guys have any questions.