Double Hand Transplant: A Medical 'Miracle'

By Toni Waterman

Nov. 3, 2011

Watch the segment that aired on Nov. 1 on WGBH's Greater Boston.

BOSTON — Richard Mangino is now resting comfortably in his Revere home, surrounded by his wife Carole and his son Robert. It's been almost a month since doctors at Brigham and Women's Hospital gave the 65-year-old grandfather of two a new grasp on life.

"I feel pretty good," he said, his voice soft over the phone. "I tried to write a bit today. I can hold a pen and move it along — push it — and write my name."

Mangino is the recipient of Brigham and Women's first successful hand transplant and now, for the first time in almost a decade, he has hands.

"The one thing that I've prayed for since my oldest grandson was born, was to be able to feel the sense of touch again. To touch his and Nicky's little face, stroke their hair and teach them to throw the ball," Mangino said.

Mangino is a quadruple amputee, having lost his arms below the elbow and his legs below the knees after contracting a blood infection in 2002. But last month, a team of more 40 doctors, nurses and support staff at Brigham and Women's Hospital painstakingly performed a double hand transplant.

"It's just like you can fly, it's like you having wings— like a bird without its wings and all of sudden you have your wings back," said Mangino.

During the more than12-hour surgery, doctors used metal plates and screws to attach the donor's forearms and hands to Mangino's arm. Once attached, lead surgeon Dr. Simon Talbot says it was all a matter of connecting the wiring.

"Next, the tendons, arteries, veins and three major nerves in the forearm are joined. Finally the remaining tendons and skin are closed."

Blood flow returns to the left hand during a bilateral hand transplant at Brigham and Women's Hospital. (Lightchaser Photography)

This photo of a half white-half pink hand shows the exact moment when blood began flowing from Mangino's arm into the donor's, bringing his new limb back to life. Within days, Mangino was able to wiggle his new fingers. And now, just three weeks later, he says he's able to feed himself chips and even dinner rolls.

"I'm not really using utensils, that's not working out yet," he said.

Dr. Bohdan Pomahac is the Director of Plastic Surgery Transplantation at Brigham and Women's Hospital and was part of Mangino's double-hand transplant team. He said Mangino is making strides in his recovery, but still has to take things slowly.

"He's in the stage where the tendon repairs are still tenuous and he could rupture it if he tried to grasp very forcefully," said Dr. Pomahac. "But at the same time, we want to keep the tendons gliding so they don't scar together."

And while Mangino is now able to move and use his new hands as if they're his own, Dr. Pomahac said it could be months before Mangino regains sensation.

"The sensation will start later. It's quite a distance for the nerve to come all the way and reach the fingertips. He probably has pro-perception, which is a feeling of what the position of the hand is based on how the muscles in the forearm connect and contract," said Dr. Pomahac.

Mangino's double hand transplant is the first successful one to take place at Brigham and Women's, which announced in August 2010 that it was developing a hand transplant program. The first procedure was done in May 2011, on Charla Nash, the Connecticut woman who was mauled by her friend's pet chimpanzee in 2009. Within 24-hours, Nash went into septic shock, contracting a life-threatening infection that forced doctors to remove her newly transplanted hands.

Dr. Pomahac says there have been just five double hand transplants nationwide, the latest one announced just this week out of the University of Pennsylvania. Worldwide, Dr. Pomahac says there have been over 30 patients and more than 50 hands transplanted.

As for Mangino, it's going to be a long road to recovery. He spends four hours a day in therapy, even more time doing exercises at home. But he said he's not discouraged, calling his chance at a new life, a miracle.

"That's the best way I can describe it. It's like you wake up out of a bad dream."

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