Hand Transplantation-Risks and Benefits

Abstract

Composite tissue allotransplantation (CTA) is the culmination of progress in transplantation, allowing the reconstruction of the hand in amputees. Worldwide, more than 100 procedures have been performed. The aim of this work was to understand the hand allotransplantation approach, making known current aspects, risks, and benefits. A PubMed research was realized between October 2018 and March 2019, including terms like "Hand transplantation" AND "Composite tissue allotransplantation," "Hand transplantation" AND "Functional outcomes," "Hand transplantation" AND "Immunosuppression," "Hand prosthetics," "Hand Transplantation" AND "Ethics." There were included papers between 1995 and 2018, with English language, amputee human adults, systematic reviews, and clinical studies. Seventy-two papers were fully evaluated. There are technical aspects that influence the procedure like team coordination or surgical technique. It requires a long-life treatment, which has risks such as toxicity or infections. However, it allows the recovery of fine movements, and independence, to perform detailed tasks. The indications must be carefully considered, because some patients benefit from the use of prosthesis. CTA has become an option for amputees so it is important to do more research, to determine the benefits of this procedure. It is not considered a life-saving procedure, so there is an ethical debate because of the risks.

Keywords: composite tissue allotransplantation; ethics; functional outcomes; hand allotransplantation; immunosuppression; rehabilitation.

Fig. 1

Methodology of the selection of the papers.

Fig. 2

The operating room set-up for bilateral hand transplant operation. Reproduced with permission from ‘The Boston Globe’–“Before and after the hand transplants.”

Fig. 3

Dissection of the recipient limb. (Reproduced with permission from Amirlak. 73 )

Fig. 4

Dissection of the donor limb. (Reproduced with permission from Amirlak. 73 )

Fig. 5

Skin flaps from both the donor and the recipient limb (with permission from Scott M. Tintle, L. Scott Levin. Bilateral Hand Transplantation, a “Life-Saving” Operation? A Case Report and Commentary. University of Pennsylvania Orthopaedic Journal . 2003; 3).

Fig. 6

Bone fixation using small set plates. (Reproduced with permission from Amirlak. 73 )

Fig. 7

Skin closure. (Reproduced with permission from Amirlak. 73 )