1
|
Laspro M, Onuh OC, Carrion K, Brydges HT, Tran DL, Chaya BF, Parker A, Thanik VD, Sharma S, Rodriguez ED. Vascularized Composite Allotransplantation of the Hand: A Systematic Review of Eligibility Criteria. Ann Plast Surg 2023; 91:771-778. [PMID: 37553908 DOI: 10.1097/sap.0000000000003659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Hand transplantation (HT) has emerged as an intervention of last resort for those who endured amputation or irreparable loss of upper extremity function. However, because of the considerable effort required for allograft management and the risks of lifelong immunosuppression, patient eligibility is critical to treatment success. Thus, the objective of this article is to investigate the reported eligibility criteria of HT centers globally. METHODS A systematic review of the HT literature was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, using PubMed, Cochrane, Ovid/Medline, and Scopus. Program Web sites and clinicaltrials.gov entries were included where available. RESULTS A total of 354 articles were reviewed, 101 of which met inclusion criteria. Furthermore, 10 patient-facing Web sites and 11 clinical trials were included. The most reported criteria related to the capacity to manage the allograft posttransplantation, including access to follow-up, insurance coverage, psychological stability, and history of medical compliance. Other factors related to the impact of immunosuppression, such as active pregnancy and patient immune status, were less emphasized. CONCLUSIONS Because of the novelty of the field, eligibility criteria continue to evolve. While there is consensus on certain eligibility factors, other criteria diverge between programs, and very few factors were considered absolute contraindications. As the popularity of the field continues to grow, we encourage the development of consensus evidence-based eligibility criteria.
Collapse
Affiliation(s)
- Matteo Laspro
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Ogechukwu C Onuh
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | | | - Hilliard T Brydges
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - David L Tran
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Bachar F Chaya
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Augustus Parker
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Vishal D Thanik
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Sheel Sharma
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Eduardo D Rodriguez
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| |
Collapse
|
2
|
Fitzpatrick SM, Brogan D, Grover P. Hand Transplants, Daily Functioning, and the Human Capacity for Limb Regeneration. Front Cell Dev Biol 2022; 10:812124. [PMID: 35309909 PMCID: PMC8930848 DOI: 10.3389/fcell.2022.812124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Unlike some of our invertebrate and vertebrate cousins with the capacity to regenerate limbs after traumatic loss, humans do not have the ability to regrow arms or legs lost to injury or disease. For the millions of people worldwide who have lost a limb after birth, the primary route to regaining function and minimizing future complications is via rehabilitation, prosthetic devices, assistive aids, health system robustness, and social safety net structures. The majority of limbs lost are lower limbs (legs), with diabetes and vascular disorders being significant causal contributors. Upper limbs (arms) are lost primarily because of trauma; digits and hands are the most common levels of loss. Even if much of the arm remains intact, upper limb amputation significantly impacts function, largely due to the loss of the hand. Human hands are marvels of evolution and permit a dexterity that enables a wide variety of function not readily replaced by devices. It is not surprising, therefore, for some individuals, dissatisfaction with available prosthetic options coupled with remarkable advances in hand surgery techniques is resulting in patients undertaking the rigors of a hand transplantation. While not “regeneration” in the sense of the enviable ability with which Axolotls can replace a lost limb, hand transplants do require significant regeneration of tissues and nerves. Regaining sophisticated hand functions also depends on “reconnecting” the donated hand with the areas of the human brain responsible for the sensory and motor processing required for complex actions. Human hand transplants are not without controversy and raise interesting challenges regarding the human regenerative capacity and the status of transplants for enabling function. More investigation is needed to address medical and ethical questions prior to expansion of hand transplants to a wider patient population.
Collapse
Affiliation(s)
- Susan M. Fitzpatrick
- James S. McDonnell Foundation, St. Louis, MO, United States
- *Correspondence: Susan M. Fitzpatrick,
| | - David Brogan
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Prateek Grover
- Division of Neurorehabilitation, Orthopaedic Surgery and Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- The Rehabilitation Institute of St Louis, St. Louis, MO, United States
| |
Collapse
|
3
|
Addressing common orthopaedic calamities with microsurgical solutions. Injury 2021; 52:3561-3572. [PMID: 34030865 DOI: 10.1016/j.injury.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 02/02/2023]
Abstract
Reconstructive microsurgery has been an essential aspect of orthopaedic surgery and extremity reconstruction since the introduction of the operating microscope in the mid-20th century. The reconstructive ladder ranges from simple healing by secondary intention to complex procedures such as free tissue transfer and vascularized composite allotransplantation. As orthopaedic surgery has evolved over the past 60 years, so too have the reconstructive microsurgical skills that are often needed to address common orthopaedic surgery problems. In this article, we will discuss a variety of complex orthopaedic surgery scenarios ranging from trauma to infection to tumor resection as well as the spectrum of microsurgical solutions that can aid in their management.
Collapse
|
4
|
Advanced Amputation Techniques in Orthopedic Surgery: Hand Transplantation. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
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.
Collapse
Affiliation(s)
- Maria João Lúcio
- Department of Plastic and Reconstructive Surgery, and Burn Unity, Centro Hospitalar Universitário de São João, Porto Medical School, University of Porto, Porto, Portugal
| | - Ricardo Horta
- Department of Plastic and Reconstructive Surgery, and Burn Unity, Centro Hospitalar Universitário de São João, Porto Medical School, University of Porto, Porto, Portugal
| |
Collapse
|
6
|
Tombak K, Özkan Ö, Uysal H, Özkan Ö. An Individualized Physiotherapy and Rehabilitation Program for Bilateral Hand Transplantations. Ann Plast Surg 2021; 86:217-222. [PMID: 33449466 DOI: 10.1097/sap.0000000000002668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
METHODS This article describes a rehabilitation program and the long-term results after its application in 2 double-hand transplantation patients after 9- and 4-year follow-up periods. A personal rehabilitation program was planned to commence as early as possible after postoperative patient stabilization. Splinting, edema, positioning, passive and active joint movements, daily life activity modification and education, and occupational therapy were also emphasized. RESULTS Positioning, edema, and passive joint movements were started in the acute phase. Strengthening and exercises were continued for 8 weeks and later for functional gains and adaptation to daily living activities. Subjective and overall results were quite satisfactory. The Hand Transplantation Score System, Disabilities of the Arm Shoulder and Hand, Semmes Weinstein Monofilaments, sensory tests, and modified Kapandji index improvements were all within good acceptable ranges. Although rapid recovery and functional development were observed in the first 4 years, these are still continuing at the time of writing. DISCUSSION The most important determining factors in the success of rehabilitation are to return to daily life and the ability to acquire functional skills. Long-term follow-up of the patients in this study showed that they were able to return to their independent daily lives and that external assistance decreased to a minimum.
Collapse
Affiliation(s)
- Kadriye Tombak
- From the Faculty of Medicine, Department of Physical Medicine and Rehabilitation
| | - Özlenen Özkan
- Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery
| | - Hilmi Uysal
- Faculty of Medicine, Department of Neurology, Akdeniz University, Antalya, Turkey
| | - Ömer Özkan
- Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery
| |
Collapse
|
7
|
Hautz T, Messner F, Weissenbacher A, Hackl H, Kumnig M, Ninkovic M, Berchtold V, Krapf J, Zelger BG, Zelger B, Wolfram D, Pierer G, Löscher WN, Zimmermann R, Gabl M, Arora R, Brandacher G, Margreiter R, Öfner D, Schneeberger S. Long-term outcome after hand and forearm transplantation - a retrospective study. Transpl Int 2020; 33:1762-1778. [PMID: 32970891 PMCID: PMC7756600 DOI: 10.1111/tri.13752] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/04/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022]
Abstract
Between 2000 and 2014, five patients received bilateral hand (n = 3), bilateral forearm (n = 1), and unilateral hand (n = 1) transplants at the Innsbruck Medical University Hospital. We provide a comprehensive report of the long-term results at 20 years. During the 6-20 years follow-up, 43 rejection episodes were recorded in total. Of these, 27.9% were antibody-related with serum donor-specific alloantibodies (DSA) and skin-infiltrating B-cells. The cell phenotype in rejecting skin biopsies changed and C4d-staining increased with time post-transplantation. In the long-term, a change in hand appearance was observed. The functional outcome was highly depending on the level of amputation. The number and severity of rejections did not correlate with hand function, but negatively impacted on the patients´ well-being and quality of life. Patient satisfaction significantly correlated with upper limb function. One hand allograft eventually developed severe allograft vasculopathy and was amputated at 7 years. The patient later died due to progressive gastric cancer. The other four patients are currently rejection-free with moderate levels of immunosuppression. Hand transplantation remains a therapeutic option for carefully selected patients. A stable immunologic situation with optimized and individually adopted immunosuppression favors good compliance and patient satisfaction and may prevent development of DSA.
Collapse
Affiliation(s)
- Theresa Hautz
- Department of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Franka Messner
- Department of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Hubert Hackl
- Division of BioinformaticsBiocenterMedical University of InnsbruckInnsbruckAustria
| | - Martin Kumnig
- Department of Psychiatry, Psychotherapy and PsychosomaticCenter for Advanced Psychology in Plastic and Transplant SurgeryMedical University of InnsbruckInnsbruckAustria
| | - Marina Ninkovic
- Department of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Valeria Berchtold
- Department of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Johanna Krapf
- Department of Plastic, Reconstructive and Aesthetic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Bettina G. Zelger
- Department of PathologyMedical University of InnsbruckInnsbruckAustria
| | - Bernhard Zelger
- Department of DermatologyMedical University of InnsbruckInnsbruckAustria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | | | - Robert Zimmermann
- Department of Plastic, Reconstructive and Aesthetic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Markus Gabl
- Department for Trauma SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Rohit Arora
- Department for Trauma SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Gerald Brandacher
- Vascularized Composite Allotransplantation (VCA) LaboratoryDepartment of Plastic and Reconstructive SurgeryJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Raimund Margreiter
- Department of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineMedical University of InnsbruckInnsbruckAustria
| |
Collapse
|
8
|
Gandhi RA, Mendenhall SD, Severance G, Levy TJ, Ben-Amotz O, Levin LS. Measuring Functional Outcomes After Bilateral Vascularized Composite Hand Allotransplantation: A Report of 3 Cases. J Hand Surg Am 2020; 45:1123-1133. [PMID: 32684347 DOI: 10.1016/j.jhsa.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 04/03/2020] [Accepted: 05/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Currently, numerous assessment tools are available to measure functional outcomes after bilateral hand transplantation. The purpose of this article is to present our experience utilizing quantitative assessment tools for functional evaluation and to describe our results after bilateral hand transplantation. METHODS A single surgeon's experience with bilateral hand transplantation from 2011 to 2016 was retrospectively reviewed. Three bilateral hand transplantations were performed in 2 adults and 1 child. A minimum 2-year follow-up evaluation was available. For the adult patients, postoperative outcome measures included patient-reported pain and disability scores, return of sensation, muscle strength, range of motion, and return to work/activities of daily living, the Hand Transplant Scoring System (HTSS), the Sollerman hand function test, and complications. For our pediatric patient, postoperative outcome measures included the Functional Independence Measure for children (WeeFIM) scale, a functional independence measure for children, the 9-Hole Peg Test, the Box and Block test, and complications. RESULTS Our 2 adult patients were age 28 and our pediatric patient was age 8 at transplantation. Follow-up ranged from 2 to 7 years. The functional assessments were performed over a period from 11 to 48 months after transplantation. Both adult patients achieved functional independence and the HTSS, Short Form-36 Health Score (SF-36), DASH, and Sollerman tests demonstrated sequential improvement compared with pretransplantation scores assessed with the use of prostheses. Our pediatric patient demonstrated improvement in his Box and Block test score for each hand at sequential visits after transplantation. His 9-Hole Peg Test demonstrated improvement, and his WeeFIM assessment at 20 months indicated a greater level of independence. CONCLUSIONS Patient-reported outcomes and the Sollerman test when used in addition to the HTSS appear to reflect functional improvement in adult patients after bilateral hand transplantation. Although children pose a unique challenge with functional assessment, we found the WeeFIM assessment, 9-Hole Peg Test, and the Box and Block test helpful in evaluating functional outcomes in our pediatric patient. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
Collapse
Affiliation(s)
- Rikesh A Gandhi
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Shaun D Mendenhall
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Gayle Severance
- Good Shepherd Penn Partners, Penn Presbyterian Medical Center, Philadelphia, PA
| | - Todd J Levy
- Center for Rehabilitation, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Oded Ben-Amotz
- Hand and Microsurgery Unit, Rambam Health Care Campus, Haifa, Israel
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
9
|
Petruzzo P, Luong S, Kanitakis J, Sardu C, Feugier P, Danjou F, Gazarian A, Badet L, Morelon E. Graft vasculopathy in upper extremity allotransplantation: Results of a retrospective high-resolution ultrasonographic study. Clin Transplant 2020; 35:e14130. [PMID: 33099801 DOI: 10.1111/ctr.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/14/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
Graft vasculopathy (GV) is the most severe pathologic change of chronic rejection in vascularized composite allotransplantation. Since 2012, the intimal media thickness (IMT) of radial and ulnar arteries was annually monitored by high-resolution ultrasonography in seven bilateral upper extremity transplant (UET) patients. We also investigated the IMT of seven matched healthy subjects (controls). No significant difference between IMT values of controls and UET patients was found. The median IMT values of recipient radial and ulnar arteries were 0.23 mm and 0.25 mm, respectively, while the median IMT values of grafted radial and ulnar arteries were 0.27 mm and 0.30 mm, respectively. There was a statistically significant difference in the IMT values of the grafted and recipient ulnar arteries (p = .043), but this difference was no longer significant when patient #2 was excluded. He showed a significant difference between recipient and grafted arteries and significantly higher IMT values (p = .001) of his grafted arteries compared with those of all transplanted patients. This patient developed GV leading to graft loss 11 years after the transplantation. In conclusion, this study showed a significant IMT increase in an UET recipient who developed GV.
Collapse
Affiliation(s)
- Palmina Petruzzo
- Department of Transplantation, Hôpital Edouard Herriot, HCL, Lyon, France.,Department of Surgery, University of Cagliari, Cagliari, Italy
| | - Stephane Luong
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, HCL, Lyon, France
| | - Jean Kanitakis
- Department of Dermatology, Hôpital Edouard Herriot, HCL, Lyon, France
| | - Claudia Sardu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Patrick Feugier
- Vascular Surgery Unit, Groupement Hospitalo-Universitaire Lyon Sud, HCL, Lyon, France.,Université Claude Bernard, Lyon1, Lyon, France
| | - Fabrice Danjou
- Département d'Information Médicale, Hôpital Saint Camille, Bry-sur-Marne, France
| | - Aram Gazarian
- Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, HCL, Lyon, France.,Chirurgie de la Main et du Membre Supérieur, Polyclinique Orthopédique de Lyon, Lyon, France
| | - Lionel Badet
- Department of Transplantation, Hôpital Edouard Herriot, HCL, Lyon, France.,Université Claude Bernard, Lyon1, Lyon, France
| | - Emmanuel Morelon
- Department of Transplantation, Hôpital Edouard Herriot, HCL, Lyon, France.,Université Claude Bernard, Lyon1, Lyon, France
| |
Collapse
|
10
|
Bilateral Proximal Forearm Transplantation: Case Report at 7 Years. Transplantation 2019; 104:e90-e97. [PMID: 31880751 DOI: 10.1097/tp.0000000000003083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although return of function has been reported in patients undergoing proximal forearm transplantations (PFTs), reports of long-term function are limited. In this study, we evaluated the clinical progress and function 7 years postoperatively in a patient who underwent bilateral PFT. CASE PRESENTATION A 58-year-old man underwent bilateral PFT in May 2012. Transplantation involved all of the flexor and extensor muscles of the forearm. Neurorrhaphies of the median, ulnar, and radial nerves were epineural and 7 cm proximal to the elbow. Immunosuppressive maintenance medications during the first 3 years postoperatively were tacrolimus, mycophenolate, and steroids, and later, tacrolimus, sirolimus, and steroids. Forearm function was evaluated annually using the Disabilities of the Arm, Shoulder, and Hand; Carroll; Hand Transplantation Score System; Short Form-36; and Kapandji scales. We also evaluated his grip and pinch force. RESULTS Postoperatively, the patient developed hypertriglyceridemia and systemic hypertension. He experienced 6 acute rejections, and none were resistant to steroids. Motor function findings in his right/left hand were: grip strength: 10/13 kg; key pinch: 3/3 kg; Kapandji score: 6/9 of 10; Carroll score: 66/80; Hand Transplantation Score System score: 90/94. His preoperative Disabilities of the Arm, Shoulder, and Hand score was 50 versus 18, postoperatively; his Short Form-36 score was 90. This function improved in relation with the function reported in the second year. CONCLUSIONS Seven years following PFT, the patient gained limb strength with a functional elbow and wrist, although with diminished digital dexterity and sensation. Based on data presented by other programs and our own experience, PFT is indicated for select patients.
Collapse
|
11
|
Functional Outcome Scores With Standard Myoelectric Prostheses in Below-Elbow Amputees. Am J Phys Med Rehabil 2019; 98:125-129. [PMID: 30153123 DOI: 10.1097/phm.0000000000001031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to report normative outcome data of prosthetic hand function in below-elbow amputees using four different objective measurements closely related to activities of daily living. DESIGN Seventeen patients who underwent prosthetic fitting after unilateral below-elbow amputation were enrolled in this study. Global upper extremity function was evaluated using the Action Research Arm Test, Southampton Hand Assessment Procedure, the Clothespin-Relocation Test, and the Box and Block Test, which monitor hand and extremity function. RESULTS The patients achieved a mean ± SD Action Research Arm Test score of 35.06 ± 4.42 of 57. The mean ± SD Southampton Hand Assessment Procedure score was 65.12 ± 13.95 points. The mean ± SD time for the Clothespin-Relocation Test was 22.57 ± 7.50 secs, and the mean ± SD score in the Box and Block Test was 20.90 ± 5.74. CONCLUSIONS In the current economic situation of health care systems, demonstrating the effectiveness and necessity of rehabilitation interventions is of major importance. This study reports outcome data of below-elbow amputees and provides a useful guide for expected prosthetic user performance.
Collapse
|
12
|
Burdon J, Taplin S, Kay SP, Wilks DJ. The functional assessment and rehabilitation programme of the UK hand and upper limb transplant service. HAND THERAPY 2019. [DOI: 10.1177/1758998319875759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction Hand and upper limb transplants are becoming internationally recognised as an effective treatment to improve function and quality of life in carefully selected patients. A comprehensive functional assessment and rehabilitation programme are an essential component of the multi-disciplinary assessment and treatment approach. Although there is an increasing body of published data on the surgical techniques and outcomes following hand transplant, little exists in the literature to guide the hand therapist. Method The pre-transplant functional assessments and rehabilitation programme provided for patients undergoing hand transplantation in the UK are described and critically analysed. The UK programme is based on that provided in Lyon, France, but adapted to suit the resources and structure of the UK National Health Service. Results Twelve patients have received a functional assessment as part of the multi-disciplinary hand transplant assessment process, with the loss of autonomy a key reason for patients seeking hand transplant. Six of these patients have received hand transplants, with patients more than one year post-transplant having achieved good and fair outcomes according to the Hand Transplantation Score System. Conclusions Although hand and upper limb transplant surgery is innovative, the therapy provided is based on the fundamental principles of good communication, accurate assessment and delivery of a bespoke rehabilitation programme; values which are common to all areas of hand therapy practice. A future study reporting the long-term outcomes of patients following hand transplant in the UK is needed to allow the effectiveness of the programme to be evaluated.
Collapse
Affiliation(s)
- Joanna Burdon
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah Taplin
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon P Kay
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel J Wilks
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
13
|
Rose J, Cooney CM, Kaufman C, Talbot SG, Caplan A, Kahn J, Sugarman J, Shores JT, Levin LS, Brandacher G, McDiarmid SV, Lee WPA, Dean W. Evolving ethics, policy and reimbursement issues of vascularized composite allotransplantation: Symposium summary. SAGE Open Med 2019. [PMID: 31384465 PMCID: PMC6661784 DOI: 10.1177/2050312119866944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this article, we present a report from a national meeting titled, “Evolving Issues of Vascularized Composite Allotransplantation—A Symposium on Ethics, Policy, and Reimbursement Issues,” which convened in September 2017. We discuss the maturation of vascularized composite allotransplantation from an emerging technology to becoming an extension of clinical practice for select patients with complex reconstructive needs. Viewpoints and action items were presented by and discussed among the 70+ clinicians, researchers, policymakers, ethicists, healthcare administrators, and third-party payers who attended the symposium with the goals of implementing a collaborative roadmap for vascularized composite allotransplantation growth, evaluation, and sustainability by establishing a unified plan to help address concerns of the public, policymakers, and healthcare finance. We review the current status of vascularized composite allotransplantation in clinical practice and summarize symposium discussions regarding ethical considerations, reimbursement, payer strategies, and standardization of data collection.
Collapse
Affiliation(s)
- John Rose
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christina Kaufman
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Simon G Talbot
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Arthur Caplan
- Division of Medical Ethics, New York University School of Medicine, New York City, NY, USA
| | - Jeffrey Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L Scott Levin
- Department of Orthopaedic Surgery, Division of Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sue V McDiarmid
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics and Surgery. David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - WP Andrew Lee
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy Dean
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| |
Collapse
|
14
|
Prosthetic Rehabilitation and Vascularized Composite Allotransplantation following Upper Limb Loss. Plast Reconstr Surg 2019; 143:1688-1701. [PMID: 31136485 DOI: 10.1097/prs.0000000000005638] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Upper limb loss is a devastating condition with dramatic physical, psychological, financial, and social consequences. Improvements in the fields of prosthetics and vascularized composite allotransplantation have opened exciting new frontiers for treatment and rehabilitation following upper limb loss. Each modality offers a unique set of advantages and limitations with regard to the restoration of hand function following amputation. METHODS Presented in this article is a discussion outlining the complex considerations and decisions encountered when determining patient appropriateness for either prosthetic rehabilitation or vascularized composite allotransplantation following upper limb loss. In this review, the authors examine how psychosocial factors, nature of injury, rehabilitation course, functional outcomes, and risks and benefits may affect overall patient selection for either rehabilitative approach. RESULTS This review summarizes the current state of the literature. Advancements in both prosthetic and biological strategies demonstrate promise with regard to facilitating rehabilitation following upper limb loss. However, there remains a dearth of research directly comparing outcomes in prosthetic rehabilitation to that following upper extremity transplantation. CONCLUSIONS Few studies have performed a direct comparison between patients undergoing vascularized composite allotransplantation and those undergoing prosthetic rehabilitation. Upper extremity transplantation and prosthetic reconstruction should not be viewed as competing options, but rather as two treatment modalities with different risk-to-benefit profiles and indications.
Collapse
|
15
|
Sharma M, Iyer S, Kishore P, Mathew J, Vijayaraghavan S, Sankaran R, Nair AN, Janarthanan R, Wakure A, Reddy R, Chetan Mali SM, Varma V, Chaudhari A, Dhake S, Omkumar A. First two bilateral hand transplantations in India (Part 3): Rehabilitation and immediate outcome. Indian J Plast Surg 2018; 50:161-167. [PMID: 29343891 PMCID: PMC5770929 DOI: 10.4103/ijps.ijps_95_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction This report covers the strategies adopted for rehabilitation for the first and second dual hand transplants performed in India. Materials and Methods The team, under a trained physiatrist, including physiotherapy and occupational therapy personnel, was involved in the management of both these patients. The management protocol was developed considering previous reports as well as our management strategies in the rehabilitation of the replanted hands. The involvement of the team with the patients started in the 1st week itself and continued on a daily basis for the entire year. Results Outcome analysis was performed at 6 months and 1 year using the disability of shoulder and hand evaluation and hand transplant scoring system. Functional magnetic resonance imaging was done at the end of 1 year to assess the cortical integration of the transplanted hand. Conclusion Despite more than 110 hands being transplanted worldwide, hand transplant remains an experimental procedure. It is still not considered the "standard of care" for hand amputees. Outcome analyses performed worldwide do indicate that the procedure can provide a substantial improvement in the quality of life for the hand amputee, especially the bilateral amputees.
Collapse
Affiliation(s)
- Mohit Sharma
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.,Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India.,Department of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - P Kishore
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Jimmy Mathew
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sundeep Vijayaraghavan
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ravi Sankaran
- Department of Physical Medicine and Rehabilitation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Arun N Nair
- Department of Physical Medicine and Rehabilitation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - R Janarthanan
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Abhijeet Wakure
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Raghuveer Reddy
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - S M Chetan Mali
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Visakh Varma
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ashish Chaudhari
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Swapnil Dhake
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Akshay Omkumar
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| |
Collapse
|
16
|
Shores JT, Malek V, Lee WPA, Brandacher G. Outcomes after hand and upper extremity transplantation. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:72. [PMID: 28361279 DOI: 10.1007/s10856-017-5880-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 06/07/2023]
Abstract
Hand and upper extremity transplantation (HUET) has emerged as the most frequently performed reconstructive procedure in the burgeoning field of vascularized composite allotransplantation (VCA). VCA refers to a form of transplant with multiple tissue types that represents a viable treatment option for devastating injuries where conventional reconstruction would be unable to restore form and function. As hand transplantation becomes increasingly more common, discussions on advantages and disadvantages of the procedure seem to intensify. Despite encouraging functional outcomes, current immunosuppressive regimens with their deleterious side-effect profile remain a major concern for a life-changing but not life-saving type of transplant. In addition, a growing number of recipients with progressively longer follow-up prompt the need to investigate potential long-term sequelae, such as chronic rejection. This review will discuss the current state of HUET, summarizing outcome data on graft survival, motor and sensory function, as well as immunosuppressive treatment. The implications of these findings for VCA in terms of achievements and challenges ahead will then be discussed.
Collapse
Affiliation(s)
- Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Veronika Malek
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Ruprecht-Karls University Heidelberg Medical Faculty, Heidelberg, Germany
| | - W P Andrew Lee
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
17
|
Salminger S, Sturma A, Roche AD, Hruby LA, Paternostro-Sluga T, Kumnig M, Ninkovic M, Pierer G, Schneeberger S, Gabl M, Chelmonski A, Jablecki J, Aszmann OC. Functional and Psychosocial Outcomes of Hand Transplantation Compared with Prosthetic Fitting in Below-Elbow Amputees: A Multicenter Cohort Study. PLoS One 2016; 11:e0162507. [PMID: 27589057 PMCID: PMC5010226 DOI: 10.1371/journal.pone.0162507] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/01/2016] [Indexed: 01/10/2023] Open
Abstract
Background Hand-transplantation and improvements in the field of prostheses opened new frontiers in restoring hand function in below-elbow amputees. Both concepts aim at restoring reliable hand function, however, the indications, advantages and limitations for each treatment must be carefully considered depending on level and extent of amputation. Here we report our findings of a multi-center cohort study comparing hand function and quality-of-life of people with transplanted versus prosthetic hands. Methods Hand function in amputees with either transplant or prostheses was tested with Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP) and the Disabilities of the Arm, Shoulder and Hand measure (DASH). Quality-of-life was compared with the Short-Form 36 (SF-36). Results Transplanted patients (n = 5) achieved a mean ARAT score of 40.86 ± 8.07 and an average SHAP score of 75.00 ± 11.06. Prosthetic patients (n = 7) achieved a mean ARAT score of 39.00 ± 3.61 and an average SHAP score of 75.43 ± 10.81. There was no significant difference between transplanted and prosthetic hands in ARAT, SHAP or DASH. While quality-of-life metrics were equivocal for four scales of the SF-36, transplanted patients reported significantly higher scores in “role-physical” (p = 0.006), “vitality” (p = 0.008), “role-emotional” (p = 0.035) and “mental-health” (p = 0.003). Conclusions The indications for hand transplantation or prosthetic fitting in below-elbow amputees require careful consideration. As functional outcomes were not significantly different between groups, patient’s best interests and the route of least harm should guide treatment. Due to the immunosuppressive side-effects, the indication for allotransplantation must still be restrictive, the best being bilateral amputees.
Collapse
Affiliation(s)
- Stefan Salminger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Agnes Sturma
- Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
| | - Aidan D. Roche
- Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Laura A. Hruby
- Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
| | - Tatjana Paternostro-Sluga
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
- Department of Physical Medicine and Rehabilitation, Danube Hospital Vienna, Vienna, Austria
| | - Martin Kumnig
- Center for Advanced Psychology in Plastic and Transplant Surgery, Department of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina Ninkovic
- Department of Physical Medicine and Rehabilitation, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Schneeberger
- Departments of General and Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Gabl
- Department of Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Adam Chelmonski
- Hand Trauma Center, St. Hedwigs’s Hospital, Trzebnica, Subdepartment of Replantation of Limbs, Trzebnica, Poland
| | - Jerzy Jablecki
- Hand Trauma Center, St. Hedwigs’s Hospital, Trzebnica, Subdepartment of Replantation of Limbs, Trzebnica, Poland
- State Higher Medical Professional School, Opole, Poland
| | - Oskar C. Aszmann
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- * E-mail:
| |
Collapse
|
18
|
Salminger S, Roche AD, Sturma A, Mayer JA, Aszmann OC. Hand Transplantation Versus Hand Prosthetics: Pros and Cons. CURRENT SURGERY REPORTS 2016; 4:8. [PMID: 26855851 PMCID: PMC4729794 DOI: 10.1007/s40137-016-0128-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Composite tissue transplantation and new developments in the field of prosthetics have opened new frontiers in the restoration of function among upper limb amputees. It is now possible to restore hand function in affected patients; however, the indications, advantages, and limitations for either hand transplantation or prosthetic fitting must be carefully considered depending on the level and extent of the limb loss. Hand transplantation allows comprehensive hand function to be restored, yet composite tissue transplantation comes with disadvantages, making this method a controversial topic in the hand surgical community. Alternatively, prosthetic limb replacement represents the standard of care for upper limb amputees, but results in the known limitations of function, sensation, and usage. The indication for hand transplantation or prosthetic fitting strongly depends on the level of amputation, as well as on the extent (unilateral/bilateral) of the amputation. In this review, we discuss the advantages and disadvantages of hand transplantation and prosthetic replacement for upper limb amputees in general, as well as in regard to the different levels of amputation.
Collapse
Affiliation(s)
- S. Salminger
- />Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- />Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
| | - A. D. Roche
- />Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
- />Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - A. Sturma
- />Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
- />Master Degree Program Health Assisting Engineering, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - J. A. Mayer
- />Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
| | - O. C. Aszmann
- />Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- />Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
19
|
Use of Video Clips to Assess the Outcomes of Bilateral Hand Transplantation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e553. [PMID: 26893978 PMCID: PMC4727705 DOI: 10.1097/gox.0000000000000539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/09/2013] [Indexed: 12/05/2022]
Abstract
Supplemental Digital Content is available in the text. Given the initial success of hand transplantation, there has been increased interest in determining functional independence and activities of daily living after hand transplantation. However, the metrics and methodologies used to study these outcomes have not yet been standardized. The goal of this article was to assess the role of video clips in assessing the outcomes of bilateral hand transplantation. We have performed 3 bilateral hand transplantations at our institution. Video clips were taken at standardized time points on our index bilateral hand transplantation patient, and the patient sent multiple home-video clips demonstrating new aspects of function when these improvements have occurred. The index patient demonstrated functional independence and activity of daily living performance without assistance in video clips ranging from 9 months to 2.5 years posttransplantation. He completed the 9-hole peg test with his left hand at 9 months follow-up and with both the hands by 1.5 years. His own video clips demonstrated his ability to perform spontaneous tasks including lawn mowing, driving and swimming. In our experience, the video tools aid in assessing outcomes of hand transplantation and may be incorporated along with multiple objective scoring tests. They can also be used to generate additional standardized tests for functional assessment and may allow retrospective grading as new scoring systems are developed.
Collapse
|
20
|
Brügger U, Plessow R, Hess S, Caballero A, Eichler K, Meyer V, von Wartburg U. The health technology assessment of the compulsory accident insurance scheme of hand transplantation in Switzerland. J Hand Surg Eur Vol 2015; 40:914-23. [PMID: 25409115 DOI: 10.1177/1753193414559463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 10/20/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Recently the decision-making committee of the compulsory Swiss accident insurance scheme needed to make a basic decision as to whether to fund hand transplantation under that scheme or not. A Health Technology Assessment was commissioned to inform decision-making and gain experience with applicability of the method. The following were main findings from various domains. Compared with prosthesis fitting, the outcome of hand transplantation is satisfactory for function and sensibility. Complications due to immunosuppression are frequent, sometimes severe and potentially life-shortening. The direct medical costs over the entire life span calculated for a 35-year-old unilaterally amputated base case patient were CHF 528,600 (EUR 438,500) higher than for a prosthesis. There are challenging ethical, legal and organizational issues. The committee decided not to reimburse hand transplantation for ethical reasons. The Health Technology Assessment has been shown to be a useful tool for decision-making in the context of Swiss accident insurance. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- U Brügger
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - R Plessow
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - S Hess
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - A Caballero
- Medical Tariff Committee for Swiss National Accident Insurance (MTK UVG), Lucerne, Switzerland
| | - K Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - V Meyer
- Department of Hand-Plastic and Reconstructive Surgery, University Hospital Zurich, Zurich, Switzerland
| | - U von Wartburg
- Division of Hand and Plastic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| |
Collapse
|
21
|
Zhang ZY, Li FC, Shao M, Yang C, Shang J, Bi ZG. Allogeneic hand transplantation and rehabilitation of hand function: a 10-year follow-up study. Int Wound J 2015; 13:1303-1308. [PMID: 26481453 DOI: 10.1111/iwj.12520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/20/2015] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study is to present the long-term outcomes of allogenic hand transplantations performed at our centre. Between January 2001 and October 2002, five allogeneic limb transplantations were performed in three patients (two bilateral forearm and one left hand transplantation). Donors and recipients were matched for blood types (ABO/Rh) and had at least two human leukocyte antigen (HLA) matches. A comprehensive rehabilitation plan integrating preoperative, intraoperative and postoperative management was developed for each patient. After 10 years, all transplantations were performed successfully without complications. As of 2014, all grafts were viable. The transplanted hands showed palmate morphology, perceived superficial pain and tactile sensations, and the static two-point discrimination ranged from 2·5 to 4·0 mm. Chronic rejection at 4 years after surgery reduced hand function in case 2. Grip strength ranged from 3 kg (case 2) to 16-18 kg (case 1) to 41-43 kg for case 3. Lifting strength ranged from 3 kg (case 2) to 21-23 kg (case 1) to 47-51 kg for case 3. They lead a completely independent life. In summary, hand function following allogeneic limb transplantation allows the ability to perform tasks of daily living.
Collapse
Affiliation(s)
- Zhen-Yu Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fu-Chun Li
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ming Shao
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Cao Yang
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jian Shang
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zheng-Gang Bi
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
22
|
Bilateral hand transplantation: Functional benefits assessment in five patients with a mean follow-up of 7.6 years (range 4–13 years). J Plast Reconstr Aesthet Surg 2015; 68:1171-83. [DOI: 10.1016/j.bjps.2015.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/09/2015] [Accepted: 07/12/2015] [Indexed: 01/10/2023]
|
23
|
Weissenbacher A, Hautz T, Pierer G, Ninkovic M, Zelger BG, Zelger B, Löscher W, Rieger M, Kumnig M, Rumpold G, Piza-Katzer H, Bauer T, Zimmermann R, Gabl M, Arora R, Ninkovic M, Margreiter R, Brandacher G, Schneeberger S, RTI-Group Innsbruck. Hand Transplantation in Its Fourteenth Year: The Innsbruck Experience. ACTA ACUST UNITED AC 2014. [DOI: 10.4161/23723505.2014.973798] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
24
|
Anjou K, Gibbs J, Purtell D, Morrison W. A new hand enhances life for quadruple amputee: A single case study. HAND THERAPY 2014. [DOI: 10.1177/1758998314542052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This single case study discusses the various challenges and rehabilitation of Australia’s first hand transplant from the hand therapy perspective. The recipient was a 65-year-old quadrimembral amputee male following overwhelming pneumococcal sepsis. Key issues included cognitive relearning following the four-year loss of cortical feedback, extrinsic muscle retraining, poor coordination and functional limitations as a result of intrinsic dennervation, and an insensate hand. Distinct clinical differences from total hand replantation included consideration of immunosuppression drugs and potential rejection episodes. Although the patient was highly motivated, a client-centred approach was critical for ongoing commitment to the intensive long-term rehabilitation programme. The recipient’s progress in the first two and a half years has been impressive with achievement of many personal goals including eating, drinking, writing, driving and lawn bowls. His results, recorded on the International Hand Transplant Registry, showed superior measurements in areas of the DASH, grip strength, and TAM of forearm, wrist, and fingers.
Collapse
Affiliation(s)
- Katie Anjou
- Hand Therapy Department, St Vincent’s Hospital, Melbourne, Australia
| | | | - Daniel Purtell
- Hand Therapy Department, St Vincent’s Hospital, Melbourne, Australia
| | - Wayne Morrison
- Plastic Surgery Department, St Vincent’s Hospital, Melbourne, Australia
| |
Collapse
|
25
|
Abstract
Composite tissue transplantation is an emerging new era in transplant medicine and has become a viable reconstructive option for patients with large and devastating tissue defects. Advances in microsurgical techniques, transplant immunology and the development of potent immunosuppressive agents have enabled the realization of such types of transplants. Over the past decade, a rapidly growing number of face and upper extremity transplantations have been performed worldwide with highly encouraging outcomes. However, despite the fact that surgical, immunological and functional results are highly encouraging, the need for long-term and high-dose immunosuppression to enable graft survival and to treat/reverse acute skin rejection episodes remains a pace-limiting obstacle towards wide spread application. In this chapter we review the history and development of this novel field, the functional and immunological outcomes based on the world experience, unique biological features of such transplants, mechanisms and treatment protocols for acute skin rejection, as well as novel concepts for immune modulation and tolerance induction.
Collapse
Affiliation(s)
- Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
26
|
Jensen SE, Butt Z, Bill A, Baker T, Abecassis MM, Heinemann AW, Cella D, Dumanian GA. Quality of life considerations in upper limb transplantation: review and future directions. J Hand Surg Am 2012; 37:2126-35. [PMID: 22938807 DOI: 10.1016/j.jhsa.2012.06.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE As reconstructive transplantation emerges as an increasingly viable option for upper limb amputees, a better understanding of quality of life (QOL) outcomes is needed to evaluate the benefits and risks of the procedure from the patient perspective. METHODS To address this need, we searched PubMed (1998-2011) to characterize QOL outcomes among upper limb transplant recipients. We identified 27 articles reporting on QOL outcomes in hand transplantation. Common instruments to assess domains of QOL in hand transplantation include the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Medical Outcomes Study Short Form-36, and the International Registry on Hand and Composite Tissue Transplantation's Hand Transplantation Score System. RESULTS Preliminary reports using standardized measures indicate that most hand transplant recipients described improved QOL. Several studies also qualitatively reported that recipients expressed satisfaction with cosmetic, sensory, functional, and social outcomes after transplantation. However, our review suggests that the measurement of QOL in hand transplantation is limited, although it is largely driven by QOL considerations. CONCLUSIONS This review highlights the need for improved measurement of QOL in hand transplantation. The preliminary QOL findings across published hand transplantation articles will aid in improving the future assessment of QOL in hand transplantation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
Collapse
Affiliation(s)
- Sally E Jensen
- Department of Medical and Social Sciences, Northwestern Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 729, Chicago, IL 60611, USA.
| | | | | | | | | | | | | | | |
Collapse
|