Boston surgeons plan double arm transplant

Katy Hayes used her hands for so much more than the routine tasks: raising a fork, turning a steering wheel, changing diapers. As a massage therapist, she used them to heal others.

That all ended 2½ years ago when Hayes, days after giving birth to her third child, developed a bacterial infection that ravaged her limbs. Doctors amputated her arms and legs to save her life. Now, Hayes herself needs healing.

Brigham and Women's Hospital surgeons said at a news conference Wednesday that the Boston hospital has approved Hayes for transplant surgery — the first double arm transplant above the elbow to be performed in the United States. She is now on the waiting list for new arms.

Hayes, an upbeat woman with an electric smile, said that she tried custom-made prosthetic limbs, but they disappointed her. They got hot in Texas, where she lived, and didn't give her the sensation of touch that had always been so important in her work.

"It didn't fulfill my heart to wear plastic and metal on me,'' she said.

During the press conference, Hayes, 44, wiped away occasional tears with what remains of her arms, which end mid­bicep. Dr. Bohdan Pomahac, ­director of plastic surgery transplantation at the hospital, held a blue bottle with a straw to her mouth so she could sip water.

She said she misses the "scars and memories'' of her limbs the way one would a close friend.

"I still feel like myself inside," she said. "I don't think of myself as different until I look in the mirror. It's hard to look in the mirror. It's hard.'' But she said she is eager to welcome the transplanted arms as "new friends."

Hayes now is waiting for an appropriate donor, who must be a female of similar skin tone. Since the procedure is experimental, insurance does not cover it; the hospital and doctors will donate their services.

After the transplant, Pomahac said, he expects Hayes eventually will be able to bend her elbows, which would allow her to get in and out of her wheelchair by herself. He also expects she will gain sensation in her new hands and move her fingers after about 18 months of rehabilitation. It is unknown whether Hayes will be able to grasp a fork or otherwise have fine motor skills in her hands — or give massages again — as doctors have had little experience with above-the-elbow transplants.

In these cases, nerve impulses must travel a long distance between the patient's own arms and the fingers, and "thousands of nerve fibers can't be matched perfectly'' in each nerve connected during transplant surgery, Pomahac said.

A similar operation was done in Germany four years ago, and that patient, a farmer who lost his arms in a combine harvester accident, is doing well, Pomahac said.

Richard Mangino, of East Boston, received a double hand transplant at Brigham almost a year ago. Like Hayes, he lost his legs and arms because of a bacterial infection, but his arms were amputated closer to his hands at his forearms. He has made tremendous progress, and has returned to his hobby of playing piano.

Hayes' illness was entirely unexpected. Several days after giving birth at home to her daughter, Arielle, now 2, Hayes experienced severe abdominal pain, and Al Hayes,her husband of 13 years, brought her to the hospital.

It turned out she had an invasive group A streptococcus infection that was destroying her organs and flesh. "I walked on my own two feet into the ER, and most of the doctors said I would die,'' she said.

While she was in a coma, her husband made the painful decision to allow amputation of her limbs as a life-saving measure. Doctors were able to save enough nerve and muscle when her arms were removed to make a transplant possible.

The couple has two other children, Amber, 18, and Jake, 8. The family has moved to the Boston area from Kingwood, Texas, in anticipation of the transplant, requiring her husband to leave his job as a middle school music teacher. They have struggled financially and have had to raise money to pay living and medical expenses over the past two years.

After the transplant, Hayes will remain in Boston for three to six months and then continue her rehabilitation at a Texas hospital.

"I have to be baby-sat, which is ridiculous,'' Hayes said. "I'm 44 years old. I'm really looking forward to having my independence back. I want to hold my husband and my child and who knows, maybe do some massage.''

Hayes said she also wants to inspire veterans of recent wars who have lost limbs and "don't want to leave the hospital because they are so embarrassed of their bodies.'' She hopes that knowledge gained from her surgery will be used to help them.

During the news conference, Hayes praised her husband, who watched from the front row, for his courage and support. She said she brought her wedding ring with her to Boston, so he can put it on her finger again after the transplant.