Our Summary

This research paper deals with the field of vascularized composite allotransplantation, which is essentially a type of transplant surgery that involves the transfer of multiple tissues like skin, muscle, bone, and blood vessels. The focus is on a case where they considered a “partial” hand transplant for a patient who had lost parts of both arms. This would have kept most of the patient’s existing hand, including a partially severed thumb with working muscle.

To determine if this was possible, the team studied the procedure using limbs from cadavers. The paper outlines the methods used, the findings from these studies, and the lessons learned. It also discusses key factors to consider for such transplants, including the reconnection of bone, planning for the restoration of blood supply, and the recovery of muscle function.

However, after their studies, the team concluded that a more traditional transplant involving the lower part of the forearm would be better for this particular patient. The paper also discusses the practical, functional, and ethical implications of this decision.

FAQs

  1. What is a partial hand transplant?
  2. What are the critical considerations for partial hand transplant candidates?
  3. Why was the partial hand approach considered inferior to a distal forearm transplant in this case?

Doctor’s Tip

A helpful tip a doctor might tell a patient considering a hand transplant is to carefully consider the feasibility and potential functional outcomes of a partial hand transplant versus a conventional distal forearm transplant. It is important to discuss and understand the risks, benefits, and limitations of each option before making a decision. Additionally, patients should be aware of the long-term implications and commitment required for post-transplant care and rehabilitation. Consulting with a multidisciplinary team of healthcare professionals, including transplant surgeons, hand therapists, and psychologists, can help ensure the best possible outcome for the patient.

Suitable For

Patients who are typically recommended for hand transplant are those who have suffered from traumatic injuries, congenital deformities, or other conditions that have led to significant loss of hand function and appearance. These patients may have undergone multiple unsuccessful surgeries or therapies to improve their hand function and quality of life. Hand transplant candidates must also have the physical and psychological readiness to undergo a high-risk procedure and commit to lifelong immunosuppressive therapy.

In some cases, patients with mid-forearm amputations or partial hand amputations may also be considered for hand transplant, depending on the extent of the injury and the potential for functional improvement with a transplant. Each patient is evaluated on a case-by-case basis by a multidisciplinary team of transplant surgeons, hand surgeons, psychiatrists, physical therapists, and other specialists to determine their suitability for a hand transplant.

Overall, hand transplant is considered for patients who have exhausted all other options for hand reconstruction and are motivated to improve their hand function and quality of life through this innovative procedure.

Timeline

Before hand transplant:

  1. Patient has a mid-forearm amputation and a contralateral metacarpal hand amputation.
  2. Patient is evaluated for a potential hand transplant.
  3. Feasibility of a partial hand transplant is studied in cadaver limbs.
  4. Issues of osteosynthesis, microvascular planning, and muscle recovery are considered.

After hand transplant:

  1. Patient undergoes hand transplant surgery.
  2. Patient undergoes rehabilitation to regain function and mobility in the transplanted hand.
  3. Patient may experience complications such as rejection or infection, which are monitored and treated.
  4. Patient continues long-term follow-up care to ensure the success of the transplant.
  5. Patient may experience improved quality of life and function in the transplanted hand.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with a hand transplant surgery?
  2. How long is the recovery process and what type of rehabilitation will be necessary after the surgery?
  3. What are the chances of rejection and what medications will be needed to prevent rejection?
  4. How will the function and sensation in the transplanted hand compare to my original hand?
  5. What are the long-term considerations and maintenance required for a hand transplant?
  6. Are there any specific criteria or tests that need to be met in order to qualify for a hand transplant?
  7. How many hand transplant procedures have you performed and what is your success rate?
  8. Are there any alternative treatments or options that should be considered before proceeding with a hand transplant?
  9. How will the cost of the hand transplant surgery and follow-up care be covered, and are there financial assistance options available?
  10. What are the expectations and limitations for daily activities and function after a hand transplant?

Reference

Authors: Shubinets V, McAndrew C, Mauch J, Glennon AR, Kovach SJ, Gray BL, Steinberg DR, Bozentka DJ, Lantieri L, Chang B, Levin LS, Lin IC. Journal: J Hand Surg Am. 2018 Jul;43(7):634-640. doi: 10.1016/j.jhsa.2018.04.031. Epub 2018 May 25. PMID: 29807842