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Kim YH, Choi YR, Joo DJ, Baek WY, Suh YC, Oh WT, Cho JY, Lee SC, Kim SK, Ryu HJ, Jeon KO, Lee WJ, Hong JW. Reaching New Heights: A Comprehensive Study of Hand Transplantations in Korea after Institutionalization of Hand Transplantation Law. Yonsei Med J 2024; 65:108-119. [PMID: 38288651 PMCID: PMC10827641 DOI: 10.3349/ymj.2023.0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE With the revision of the Organ and Transplantation Act in 2018, the hand has become legal as an area of transplantable organs in Korea. In January 2021, the first hand allotransplantation since legalization was successfully performed, and we have performed a total of three successful hand transplantation since then. By comparing and incorporating our experiences, this study aimed to provide a comprehensive reconstructive solution for hand amputation in Korea. MATERIALS AND METHODS Recipients were selected through a structured preoperative evaluation, and hand transplantations were performed at the distal forearm level. Postoperatively, patients were treated with three-drug immunosuppressive regimen, and functional outcomes were monitored. RESULTS The hand transplantations were performed without intraoperative complications. All patients had partial skin necrosis and underwent additional surgical procedures in 2 months after transplantation. After additional operations, no further severe complications were observed. Also, patients developed acute rejection within 3 months of surgery, but all resolved within 2 weeks after steroid pulse therapy. Motor and sensory function improved dramatically, and patients were very satisfied with the appearance and function of their transplanted hands. CONCLUSION Hand transplantation is a viable reconstructive option, and patients have shown positive functional and psychological outcomes. Although this study has limitations, such as the small number of patients and short follow-up period, we should focus on continued recovery of hand function, and be careful not to develop side effects from immunosuppressive drugs. Through the present study, we will continue to strive for a bright future regarding hand transplantation in Korea.
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Affiliation(s)
- Yo Han Kim
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
- Organ Transplantation Center, Severance Hospital, Seoul, Korea
| | - Dong Jin Joo
- Organ Transplantation Center, Severance Hospital, Seoul, Korea
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Yeol Baek
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Young Chul Suh
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Won Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Yong Cho
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Chul Lee
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kyum Kim
- Department of Diagnostic Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyang Joo Ryu
- Department of Diagnostic Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Ock Jeon
- Organ Transplantation Center, Severance Hospital, Seoul, Korea
| | - Won Jai Lee
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Hong
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
- Organ Transplantation Center, Severance Hospital, Seoul, Korea.
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Persitz J, Khan S, Kim G, Alhujayri AK, Lorquet E, Baltzer H. Functional and patient-reported outcomes following single digit replantation: A systematic literature review. HAND SURGERY & REHABILITATION 2023; 42:379-385. [PMID: 37453715 DOI: 10.1016/j.hansur.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Finger amputations can involve different levels of injury complexity, and the success of a finger replantation is further shaped by a variety of factors, including patient characteristics, surgical technique, and postoperative rehabilitation. These variables may interact in complex ways and contribute to heterogeneity that makes it challenging to guide management for individual patients. As such, this systematic review seeks review the outcomes of isolated single digit replantation and compare patient reported outcomes following revision amputation to guide decision making. METHODS The United States National Library of Medicine (PubMed/Medline), EMBASE and CINAHL were systematically searched to identify publications relevant to this systematic review. Related articles that were published from database inception to October 15, 2022 were extracted. The inclusion criteria consisted of English language clinical trials and observational studies reporting any functional or patient-reported outcome following single digit replantation. RESULTS From the initial 1050 titles and abstracts that were eligible for screening, six studies representing 550 single digit replantations were included. There were 162 replanted thumbs (162/550), as reported in three studies, and 388 replanted fingers (388/550), as reported in all six studies. Overall, all six studies concluded that non-thumb single digit replantation can provide satisfactory outcomes. Five studies suggested that single digit replantation proximal to flexor zone II can have reasonable outcomes in select cases. Two of the comparative studies (Zhu et al. [1], Chung et al. [2]) showed a statistically significant increase in MHQ score in the non-thumb replant group in comparison to the revision amputation group (87.6 versus 84.6 respectively). CONCLUSION When technically feasible, replantation is recommended, even in select index finger zone II amputations. Single digit replantation does not restore pre-injury hand function but does result in acceptable hand function when successful. Further study is needed to better inform risk-stratification of patients, and guide patient, and surgeon expectations for post-operative recovery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jonathan Persitz
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada.
| | - Shawn Khan
- University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Grace Kim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Abdulaziz K Alhujayri
- Division of Plastic Surgery, Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Etienne Lorquet
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Heather Baltzer
- Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Plastic, Reconstructive and Aesthetic Surgery, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University of Toronto, Temerty Faculty of Medicine, Toronto, Ontario, Canada
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Personalized Treatment Decisions for Traumatic Proximal Finger Amputations: A Retrospective Cohort Study. J Pers Med 2023; 13:jpm13020215. [PMID: 36836449 PMCID: PMC9964272 DOI: 10.3390/jpm13020215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
Ray and proximal phalanx amputations present valid surgical options for the management of severe traumatic finger injuries. However, among these procedures, the superior one for optimal functionality and quality of life for patients still remains unknown. This retrospective cohort study compares the postoperative effects of each amputation type to provide objective evidence and to create a paradigm for clinical decision-making. A total of forty patients who had received either ray or proximal phalanx-level amputations reported on their functional outcomes using a combination of questionnaires and clinical testing. We found a decreased overall DASH score following ray amputation. Particularly, Part A and Part C of the DASH questionnaire were consistently lower compared with amputation at the proximal phalanx. Pain measurements in the affected hand were also significantly decreased during work and at rest in ray amputation patients, and they reported decreased cold sensitivity. Range of motion and grip strength were lower in ray amputations, which is an important preoperative consideration. We found no significant differences in reported health condition, evaluated according to the EQ-5D-5L, and blood circulation in the affected hand. We present an algorithm for clinical decision-making based on patients' preferences to personalize treatment.
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