Hand transplants is a surgical procedure for hand transplant from one person to another. The "donor" hand usually comes from a brain-dead donor and is transplanted to a recipient who has lost one or both arms. Most hand transplants to date have been performed under the elbow amputated, although above the elbow transplant gained popularity. Hand transplants are the first of a new category of transplants in which some organs are transplanted as a functional unit, now called "Vascularized Composite Allotransplantation" or VCA.
The operation is quite extensive and usually lasts from 8-12 hours. For comparison, a typical heart transplant surgery lasts 6 to 8 hours. Surgeons usually connect the bone first, followed by tendons, arteries, nerves, veins, and skin.
Hand transplant recipients need to take immunosuppressive drugs similar to other transplants such as the kidney or liver, because the body's natural immune system will try to resist, or destroy, the hand. These drugs cause the recipient to have a weaker immune system that can lead to an increased risk of infection and some cancers. There have been many advances in solid organ transplants over the years that make these drugs quite tolerable.
After transplantation, there is a period of extensive hand therapy/rehabilitation that helps recipients regain the function of transplanted hands. Patients who are dedicated to taking drugs and doing physical therapy after hand transplants have tremendous success in regaining the function of the new hand/arm.
Video Hand transplantation
History
Hand transplants were performed in Ecuador in 1964, but patients experienced transplant rejection after just two weeks because of the primitive nature of the immune suppressant at the time.
The first short-term success in human hand transplants occurred with New Zealand citizen Clint Hallam who lost his hand in an accident while in jail. The operation was conducted on 23 September 1998 in Lyon, France by teams gathered from various countries around the world including Prof. Nadey Hakim representing Britain, and Professor Jean-Michel Dubernard of France. A team microsurgeon expert, Earl Owen from Australia, knows the secrets of detailed, largely unpublished, basic research that has been carefully collected by the team in Louisville. After the surgery, Hallam was uncomfortable with the idea of ​​his transplanted hands and failed to follow the prescribed postoperative medication and physiotherapy. His inaccurate hope sets a concrete example of the need for a fully committed team of caregivers, including psychologists, who can select and prepare the right potential transplant recipients for a long and difficult recovery and the simple functional recovery of the expected transplanted hands.. Hallam's transplant hand was removed at his request by transplant surgeon Nadey Hakim on February 2, 2001 following another episode of denial.
The first hand transplant to achieve long-term success was directed by Kleinert's Klein Hand Care surgeon team including Warren C. Breidenbach, Tsu-Min Tsai, Luis Scheker, Steven McCabe, Amitava Gupta, Russell Shatford, William O'Neill, Martin Favetto and Michael Moskal in collaboration with Christine M. Kleinert Institute, Jewish Hospital and Louisville University in Louisville, Kentucky. This procedure was performed on New Jersey native Matthew Scott on January 14, 1999. Scott has lost his hand due to a firework accident at the age of 24 years. Then in 1999, the Philadelphia Phillies baseball team asked him to pay homage to the ceremony for the first time. tone. The Louisville Group went on to transplant the first five hands in the United States and has performed 12 hand transplants in ten recipients by 2016.
Unlike previous efforts at the hands of transplants, the Louisville group has conducted extensive scientific research and feasibility studies for many years before their first clinical procedure (eg, Shirbacheh et al. , 1998). There is also considerable transparency and supervision of institutional review boards involved in screening and selecting prospective patients.
In March 2000, a team of surgeons at the University of Innsbruck in Austria started a series of three bilateral hand transplants for six years. The first was an Austrian police officer who lost both hands trying to defuse the bomb. He has completed a motorcycle trip around the world using his transplanted hands.
University of Louisville Doctors also performed successful hand transplants at Michigan Jerry Fisher in February 2001, and Michigan resident David Savage in 2006.
On January 14, 2004, the team of Professor Jean-Michel Dubernard (Edouard-Herriot Hospital, France) stated that a five-year-old double-handed transplant succeeded. Lessons learned in this case, and in 26 other hand transplants (6 doubles) that occurred between 2000 and 2005, provided impetus for other organ transplant surgeries such as face, abdominal wall and larynx.
On May 4, 2009 Jeff Kepner, Augusta, Georgia, a 57-year-old resident, underwent the first double-handed transplant in the United States at the University of Pittsburgh Medical Center by a team led by W.P. Andrew Lee, who has also done a careful basic research on such transplants over the years. A CNN story on its follow-up shows the limited functional restoration expected, especially after bilateral transplantation.
On February 18, 2010, the first woman in the United States underwent a hand transplant at Wilford Hall Medical Center in San Antonio, Texas. This procedure is performed by a surgeon from The Hand Center of San Antonio and the US Air Force.
On June 22, 2010, a Polish army received two new hands from a female donor, after losing them three years earlier while storing a young man recruited from a bomb.
On March 8, 2011, 26-year-old Emily Fennell underwent an 18 hour operation to install her right hand. This was done at Ronald Reagan UCLA Medical Center.
March 12, 2011 Linda Lu became the recipient of first-hand transplants in the Southeast, conducted at Emory University Hospital, from donor Leslie Sullivent.
In the fall of 2011, 28-year-old Lindsay Ess received a double-handed transplant at the University of Pennsylvania Hospital in an 11 1/2 hour operation.
On December 27, 2012, Mark Cahill, 51, received a right hand transplant at Leeds General Infirmary in England. The recipient's hands have been removed during the same 8-hour operation, reportedly allowing a highly accurate recovery of the nerve structure, believed to be the first in the international world.
On 27 February 2013, Eskandar Moghaddami, 38, received a hand-grafted operation by plastic surgery team of Khordad Hospital 15th in Tehran, Iran.
On January 13, 2015, doctors at the Kochi-based Amrita Institute of Science and Medical Research (AIMS) successfully performed a first-hand transplant in India. A 30-year-old man, who lost both his hands in a train accident, received the hand of a 24-year-old accident victim.
On July 28, 2015, Doctors at Philadelphia Children's Hospital performed the first successful bilateral hand transplant on a child. At the age of 2 years, Sion Harvey lost her hands and feet from a life-threatening infection, 6 years later, at the age of 8, Sion had both hands replaced with double handed transplants.
On October 26, 2016, Director of hand transplants at UCLA, Dr. Kodi Azari and his team, performed hand transplants at the 51-year-old entertainment executive from Los Angeles, Jonathan Koch at Ronald Reagan UCLA Medical Center. Koch underwent a 17-hour procedure to replace his left hand, he lost a life-threatening mysterious illness that attacked him in January 2015. On June 23, 2015, Koch underwent an amputation surgery also performed by Dr. Kodi Azari, was designed to prepare him for receiving the transplanted branch, which included cutting the left hand closer to the wrist than the elbow. Azari keeps all the nerves and tendons long and extended, which will give him many things to do later. Then he sewed it together and taped it to the bone stump so as not to pull it. This is the first known case of hand transplantation in which the hand is amputated as a preparation for hand transplantation compared to a previous hand transplant patient who has undergone a typical amputation surgery. Azari's theory, which prepares the hand for transplantation during the initial amputation operation, will later be supported by Koch when he is able to move his thumb just 2 hours after he wakes up from a transplant operation for 17 hours and moves his entire hand just 2 days after surgery. In addition to LA Magazine and The Times, Koch's story is further documented on ABC's Nightline with Juju Chang airing May 18, 2017 with the aim of making more people aware of hand transplants. On 7 Feb 2018, Prof V Ramadevi and team performed the first bilateral hand transplants at the Institute of researche and rehabilitation for hands and dept., Plastic surgery, Govt., Stanley medical college, Chennai, India. This is a first-hand transplant performed at Govt., Hospital across the state.
Maps Hand transplantation
Long Term Functionality
Long-term functionality varies from patient to patient and is affected by several factors including amputation and transplantation rates and participation in post-operative physical hand transplant therapy. The hand transplant recipient Jonathan Koch was able to pick up a napkin and tennis ball with his newly transplanted hand 7 days after the 17 hour operation and on the 9th day, he could take a bottle of water and drink. 3 months after surgery, Koch can use his transplanted hands to tie his shoes.
Survival rate
Although the one-year survival rate of transplanted hands has been excellent in institutions fully committed to procedures, the number of hand transplants performed after 2008 has been small due to drug-related side effects, uncertain long-term outcomes, and high cost of surgery, rehabilitation and immunosuppression.
Program
United States
Johns Hopkins University School of Hands and Transplant Medicine Program - Led by W. P. Andrew Lee, MD. Located in Baltimore, MD, the program is approved by Johns Hopkins Drug Institute Review Council in July 2011. This is one of only 2 courses in the United States approved for performing hand/arm transplants using an immunomodulatory protocol, allowing patients to take 1 drug (not 3) after transplant to maintain the hand or arm. The program is funded by the US Army Medical Research and Materiel Command (MRMC) Institute for Regenerative Armed Forces Medicine (AFIRM) for transplantation of up to 6 Injured Warriors or civilians who have hand or arm amputations on one or both sides.
University of Southern Illinois Medical School Hand Transplant Program - Led by Dr. Michael W. Neumeister, MD, FRCS (C), FACS, SIU hand transplant program located in Springfield, Illinois. The program was officially launched in January 2014 after receiving IRB approval and grant funds for five patient, unilateral or bilateral transplants, at a minimal cost for patients.
UCLA Hand Transplant Program - Led by Dr. Kodi Azari, MD, FACS, located in Los Angeles, CA, the program was launched July 28, 2010 and at that time was the only one on the West Coast and one of only four in the country.
United Kingdom
In 2016 it was announced that NHS patients in the UK would be the first people in the world to benefit from hand-rolling and a publicly funded upper arm transplant delivered by a team of specialists at Leeds General Infirmary.
References
Further reading
Ambitak B, Gonzalez R, Gorantla V, Breidenbach WC, Tobin GR (April 2007). "Making hand transplant program". Clin Plast Surg . 34 (2): 279-89, x. doi: 10.1016/j.cps.2007.01.002. PMIDÃ, 17418677.
External links
- www.handtransplant.org
- www.siumed.edu/handtransplant
- The first successful hand transplant in the world
- The New York Times <6, 2005, "Pioneering Transplant, and Now an Ethical Storm"
- CNN, May 8, 2009, "Pastry chef receives a double hand transplant"
Source of the article : Wikipedia
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