Our Summary

This research paper examines the issue of timing in the surgical reattachment of amputated fingers. Traditionally, it’s been believed that the success of such surgeries is largely determined by how quickly they are performed after the finger is severed, with the finger thought to become less viable after 6 hours at normal temperatures and 12 hours if kept cold. However, this study suggests that these time limits might not be as strict as previously believed. The authors have found that there isn’t a lot of solid evidence to support these traditional time limits, and there’s recent data that suggests delayed reattachment might be possible. The common approach to treating these injuries often involves transferring the patient or performing emergency surgeries overnight, which can be costly and limit the availability of this type of surgery. The authors suggest that if protocols were updated based on new evidence, it could lead to the surgery being more widely available and could improve the quality of care.

FAQs

  1. What is the significance of ischemia time after digit amputation?
  2. What evidence supports the feasibility of delayed digit replantation?
  3. How could changes to digit replantation protocols improve care quality and availability?

Doctor’s Tip

A doctor might tell a patient undergoing a hand transplant that following a strict regimen of physical therapy and rehabilitation is essential for a successful outcome. It is important to work closely with your healthcare team to ensure proper healing, function, and mobility in the transplanted hand. Consistent follow-up appointments and adherence to post-operative instructions are crucial for a successful recovery.

Suitable For

Patients who may be recommended for hand transplant surgery typically include those who have experienced traumatic amputations that have resulted in significant loss of function and quality of life. These patients may have lost multiple digits or even an entire hand, making it difficult for them to perform daily activities and tasks. Additionally, patients who have undergone unsuccessful replantation surgeries or have experienced complications with their replanted digits may be candidates for hand transplant surgery. It is important for patients to be in good overall health and have realistic expectations for the outcomes of the surgery in order to be considered for hand transplant.

Timeline

Before hand transplant:

  1. Patient experiences a traumatic event leading to severe hand injury or loss, such as a crush injury, traumatic amputation, or severe burn.
  2. Patient undergoes initial evaluation and treatment by a medical team to stabilize their condition and assess the extent of the hand injury.
  3. Patient may undergo multiple surgeries to attempt to repair or reconstruct the damaged hand, but the outcome may not be optimal for functional use.
  4. Patient may be referred to a hand transplant center for evaluation as a potential candidate for a hand transplant.

After hand transplant:

  1. Patient undergoes a comprehensive evaluation and screening process to determine their eligibility for a hand transplant.
  2. Patient is placed on a waiting list for a suitable donor hand to become available.
  3. Patient undergoes the hand transplant surgery, which can take several hours and involves connecting nerves, blood vessels, and tendons.
  4. Patient begins a rigorous rehabilitation program to regain function and strength in the transplanted hand.
  5. Patient requires long-term follow-up care to monitor for complications, rejection, and to optimize function of the transplanted hand.
  6. Patient may need to take immunosuppressant medications for the rest of their life to prevent rejection of the transplanted hand.

What to Ask Your Doctor

  1. What is the success rate of hand transplant surgery?
  2. What are the potential risks and complications associated with hand transplant surgery?
  3. How long is the recovery process after hand transplant surgery?
  4. What type of rehabilitation or physical therapy will be required after the surgery?
  5. How will hand transplant surgery impact my daily activities and quality of life?
  6. What are the long-term outcomes and potential challenges of hand transplant surgery?
  7. How will the medication I need to take after the surgery affect me?
  8. What is the expected lifespan of a transplanted hand?
  9. Are there any specific lifestyle changes I need to make after the surgery?
  10. What is the likelihood of rejection of the transplanted hand and how is it managed?

Reference

Authors: Harbour PW, Malphrus E, Zimmerman RM, Giladi AM. Journal: J Hand Surg Am. 2021 Oct;46(10):908-916. doi: 10.1016/j.jhsa.2021.07.007. Epub 2021 Aug 8. PMID: 34376294