Hand Transplantation, An Issue of Hand Clinics

W. P. Andrew Lee, Gerald Brandacher

Description

The History and Evolution of Hand Transplantation, World Experience After More Than a Decade of Clinical Hand Transplantation, How to Establish a Hand Transplant Program, Recipient Selection – Who is the Right Candidate for Hand Transplantation? Donor-related Issues in Hand Transplantation, Surgical and Technical Aspects of Hand Transplantation – Is it Just Another Replant? Functional Outcome After Hand Transplantation – What can be Achieved? Strategies to Enhance Nerve Regeneration, Immunosuppressive Protocols and Immunological Challenges Related to Hand Transplantation, Acute and Chronic Rejection in Hand Transplantation – What have we Learned? Favoring the Risk Benefit Balance for Hand Transplantation – The Pittsburgh Approach Ethical, Financial and Policy Considerations of Hand Transplantation

Sujets

• Medical
• Médecine
• Orthopedics

Informations

• Publié par: Saunders
• Date de parution: 28 août 2011
• Nombre de lectures: 0
• EAN13: 9781455709304
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Hand Clinics , Vol. 27, No. 4, November 2011
ISSN: 0749-0712
doi: 10.1016/S0749-0712(11)00095-3

Contributors
Hand Clinics
Hand Transplantation
Gerald Brandacher, MD
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Ross Research Building 749D, 720 Rutland Avenue, Baltimore, MD 21205, USA
W.P. Andrew Lee, MD
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
ISSN  0749-0712
Volume 27 • Number 4 • November 2011

Contents
Cover
Contributors
Forthcoming Issues
Hand Transplantation
The History and Evolution of Hand Transplantation
World Experience After More Than a Decade of Clinical Hand Transplantation: Update on the French Program
World Experience After More Than a Decade of Clinical Hand Transplantation: Update from the Louisville Hand Transplant Program
World Experience After More Than a Decade of Clinical Hand Transplantation: Update on the Innsbruck Program
World Experience After More Than a Decade of Clinical Hand Transplantation: Update on the Polish Program
The Spanish Experience with Hand, Forearm, and Arm Transplantation
Functional Outcome after Hand and Forearm Transplantation: What Can Be Achieved?
Immunosuppressive Protocols and Immunological Challenges Related to Hand Transplantation
Acute and Chronic Rejection in Upper Extremity Transplantation: What Have We Learned?
Clinical Strategies to Enhance Nerve Regeneration in Composite Tissue Allotransplantation
Favoring the Risk–Benefit Balance for Upper Extremity Transplantation—The Pittsburgh Protocol
Surgical and Technical Aspects of Hand Transplantation: Is it Just Another Replant?
Development of an Upper Extremity Transplant Program
Recipient Screening and Selection: Who is the Right Candidate for Hand Transplantation
Donor-Related Issues in Hand Transplantation
Ethical, Financial, and Policy Considerations in Hand Transplantation
Arthroscopic Dorsal Capsuloligamentous Repair in Chronic Scapholunate Ligament Tears
Index
Hand Clinics , Vol. 27, No. 4, November 2011
ISSN: 0749-0712
doi: 10.1016/S0749-0712(11)00097-7

Forthcoming Issues
Hand Clinics , Vol. 27, No. 4, November 2011
ISSN: 0749-0712
doi: 10.1016/j.hcl.2011.08.009

Preface
Hand Transplantation

Gerald Brandacher, MD
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Ross Research Building 749D, 720 Rutland Avenue, Baltimore, MD 21205, USA
E-mail address: [e-mail]
E-mail address: [e-mail]

W.P. Andrew Lee, MD
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
E-mail address: [e-mail]
E-mail address: [e-mail]


Gerald Brandacher, MD, Guest Editor

W.P. Andrew Lee, MD, Guest Editor
Reconstructive transplantation has become a clinical reality over the past decade with more than 70 upper limb transplants performed with highly encouraging graft survival and good to excellent functional outcomes.
This special issue of Hand Clinics is devoted to Hand Transplantation. The individual authors are leaders in the field with extensive knowledge and expertise in their particular assignments. The goal for this issue is to cover the various multidisciplinary aspects related to hand transplantation with a focus on clinical and immunological outcomes. This is achieved with a series of articles from some of the leading centers performing hand transplantation in Europe and the United States, providing detailed updates on their experience with hand and forearm transplantation. This cumulative world record substantiates the fact that hand transplantation today is a valuable treatment option for the many patients in need suffering from complex tissue injuries or defects where conventional reconstruction is not feasible.
However, despite the fact that surgical procedures and functional outcomes are largely successful, the need for long-term and high-dose multidrug immunosuppression to enable graft survival still remains a pace-limiting obstacle toward broader application. We therefore devote an entire section to immunosuppressive protocols and immunological challenges related to hand transplantation and to the recognition of acute and chronic rejection mechanisms.
In addition, unlike for solid organs, clinical success in hand transplantation is dictated not only by graft acceptance and survival, but also by nerve regeneration, which determines ultimate functional outcomes. This important topic is dealt with in an article discussing novel strategies and modalities to enhance nerve regeneration. In this regard, several exciting novel therapeutic strategies such as the implementation of cellular and biologic therapies that integrate the concepts of immune regulation with those of nerve regeneration are on the horizon and have shown promising results in experimental models. Such protocols might further optimize functional outcomes and minimize/avoid the need for chronic immunosuppression.
With more and more centers embarking on reconstructive transplantation, logistical aspects, and standardization of the transplant procedure, patient care and postoperative follow-up are of critical importance. Consequently, a sequence of articles are incorporated in this issue to review surgical techniques, establishment of a hand transplant program, criteria for recipient selection, donor-related issues, as well as general ethical, financial, and policy considerations of hand transplantation.
Today we are on the verge of a new era in upper limb transplantation. The constantly improving safety, efficacy, and applicability of these promising reconstructive modalities hold great promise for patients with devastating injuries or deformities that are not amenable to conventional methods of repair.
Hand Clinics , Vol. 27, No. 4, November 2011
ISSN: 0749-0712
doi: 10.1016/j.hcl.2011.07.005

The History and Evolution of Hand Transplantation

Abtin Foroohar, MD a , River M. Elliott, MD b , Tae Won Benjamin Kim, MD a , Warren Breidenbach, MD c , d , Abraham Shaked, MD, PhD e , L. Scott Levin, MD a , f , *
a Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
b Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
c Division of Plastic Surgery, University of Arizona School of Medicine, Tuscon, AZ, USA
d Division of Reconstructive and Plastic Surgery, Tuscon, AZ, USA
e Division of Transplant Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
f Department of Orthopaedic Surgery, Plastic Surgery Hospital of the University of Pennsylvania, 2 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
* Corresponding author. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
E-mail address: [e-mail]

Abstract
Hand transplantation has proven itself to be a viable treatment option for upper extremity reconstruction. It has grown through advancements in several critical areas: microsurgery, transplant immunology, and hand surgery. The field has also benefited from a global effort with active transplant centers in 3 different continents. The early struggles and breakthroughs of hand transplantation's past have shaped and formed its current state. This article traces the events of the modern era of hand transplantation.

Keywords
• Hand transplantation • Allotransplant • History
As part of the rapidly expanding vascularized composite allotransplantation (VCA), hand transplantation combines the technical rigors of hand surgery and microsurgery with the complex multidisciplinary care that defines modern solid organ transplantation. Although hand transplantation and solid organ transplantation share a common history characterized by important advances in immunosuppression and surgical technique, hand transplantation has not yet been performed on a scale approaching that of solid organ transplants. The technical demands of hand transplantation, enhanced donor antigen burden of the hand allograft, and complex psychosocial issues pertaining to the recipient account for much of the discrepancy between these 2 related fields. Despite these unique challenges, hand transplantation remains a viable option today for hand amputees and the standard of care for bilateral upper extremity amputees. The early struggles and breakthroughs of hand transplantation’s past have shaped and formed its current state.

Hand transplantation and the microsurgical reconstructive ladder
The reconstructive ladder refers to a well-known principle of soft tissue reconstruction that places the simplest methods of wound closure at the bottom rung and increases in complexity as one moves upward. Classically, free tissue transfer represented the highest step. Microsurgery and upper extremity surgery, however, have developed over the last half century, leading to functional muscle transfers, nerve transfers, chimeric flaps, flap expansion and prefabrication, perforator flaps, and ultimately VCA. Consequently, free tissue transfer can be expanded into its own reconstructive microsurgical ladder, ascending from simple microsurgi