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Shubinets V, McAndrew C, Mauch J, Glennon AR, Kovach SJ, Gray BL, Steinberg DR, Bozentka DJ, Lantieri L, Chang B, Levin LS, Lin IC. Partial Hand Transplant: Lessons Learned From Cadaveric Dissection Studies. J Hand Surg Am 2018; 43:634-640. [PMID: 29807842 DOI: 10.1016/j.jhsa.2018.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 03/23/2018] [Accepted: 04/24/2018] [Indexed: 02/02/2023]
Abstract
As the field of vascularized composite allotransplantation continues to expand, new upper extremity transplant candidates are being considered. We recently evaluated a bilateral amputee who had a mid-forearm amputation and a contralateral metacarpal hand amputation. In the latter limb, a "partial" hand transplant that preserved the majority of the patient's existing hand, including a partially severed thumb with intact thenar muscle function, was proposed. The feasibility of this partial hand transplant was studied in fresh-frozen cadaver limbs. This report details the proposed approach, the cadaveric dissections, and the lessons learned from these dissections. Issues of osteosynthesis, microvascular planning, and intrinsic muscle recovery are discussed, all of which are critical considerations for partial hand transplant candidates. Ultimately, the partial hand approach was felt to be inferior to a more conventional distal forearm transplant in this particular candidate. Practical, functional, and ethical implications of such decision are presented.
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Affiliation(s)
- Valeriy Shubinets
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Christine McAndrew
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Jaclyn Mauch
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Stephen J Kovach
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Benjamin L Gray
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - David R Steinberg
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - David J Bozentka
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Laurent Lantieri
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hôpital Européen Georges Pompidou, Paris, France
| | - Benjamin Chang
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ines C Lin
- Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA.
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Affiliation(s)
- C Fontaine
- Service de chirurgie de la main et du membre supérieur, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, CHRU, rue du Pr-Émile-Laine, 59037 Lille cedex, France.
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M M, H G, S H, A J, Khan W. The future of rheumatoid arthritis and hand surgery - combining evolutionary pharmacology and surgical technique. Open Orthop J 2012; 6:88-94. [PMID: 22423304 PMCID: PMC3296114 DOI: 10.2174/1874325001206010088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 10/22/2011] [Accepted: 10/30/2011] [Indexed: 11/22/2022] Open
Abstract
Rheumatoid arthritis is a systemic autoimmune disease of uncertain aetiology, which is characterized primarily by synovial inflammation with secondary skeletal destructions.Rheumatoid Arthritis is diagnosed by the presence of four of the seven diagnostic criteria, defined by The American College of Rheumatology.Approximately half a million adults in the United Kingdom suffer from rheumatoid arthritis with an age prevalence between the second and fourth decades of life; annually approximately 20,000 new cases are diagnosed.The management of Rheumatoid Arthritis is complex; in the initial phase of the disease it primarily depends on pharmacological management. With disease progression, surgical input to correct deformity comes to play an increasingly important role. The treatment of this condition is also intimately coupled with input from both the occupational therapists and physiotherapy.
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Affiliation(s)
- Malahias M
- Department of Plastic Surgery, Countess of Chester Hospital, Liverpool Road, Chester. CH21UL, UK
| | - Gardner H
- Department of Plastic Surgery, Countess of Chester Hospital, Liverpool Road, Chester. CH21UL, UK
| | - Hindocha S
- Department of Plastic Surgery, Countess of Chester Hospital, Liverpool Road, Chester. CH21UL, UK
- Department of Plastic Surgery, Whiston Hospital, Warrington Road, L355DR, UK
| | - Juma A
- Department of Plastic Surgery, Countess of Chester Hospital, Liverpool Road, Chester. CH21UL, UK
| | - W Khan
- University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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