Hand Transplantation

About this book

Transplanting a limb has been a dream of humanity – until 1998 when an international team of surgeons gathered in Lyon, France, and performed the first hand transplantation in history. Since then, groups in the United States, China, Austria, Italy and Belgium have launched hand transplantation programmes. In 2002, the International Registry on Hand and Composite Tissue Transplantation (IRHCTT) was created with the purpose of collecting and analysing data from every centre. This book presents the global experimental and clinical experience on hand transplantation and all types of other composite tissue allografts so far performed. A complete review of all aspects of these innovative and ground-breaking procedures is clearly presented in 15 different sections. They include the experimental basis of hand transplantation, strategies for selecting ideal candidates and preparing successful hand transplantation programmes, surgical techniques, most effective immunosuppressive drug regimes, analysis of the unique immunological behaviour of these transplants and rehabilitation protocols to achieve optimal sensory and motor recovery. Each section is dedicated to a special issue, such as psychological and medicolegal implications, brain remodelling after hand transplantation and introduction of a new scoring system for overall comprehensive outcome evaluation. A complete list of composite tissues allografts currently carried out around the world is reported in detail, including the face, abdominal wall, uterus, larynx and knee joint. A selection of videos highlights functional outcome of the transplanted hands in the daily activities and professional lives of these patients. This book is a milestone in the medical literature and represents a great asset for every scientific library.

Written for:

Scientists, libraries, institutes

Keywords:

• Amputation
• Composite tissue allograft
• Hand transplantation
• Rehabilitation and physiotherapy of skeletal disorders
• Upper limb reconstruction

Table of contents

Historical remarks: Cosma and Damian revisited.- Experimental limb transplantation: Rodents. Primates.- Organization of a hand transplantation program: Selection of the candidates and waiting list. Dealing with the media and the public. Setting up a pilot study and clinical trial. Organization and staff requisites for hand transplantation.- Ethics of non life-saving transplantation.- Immunology of hand transplantation: Skin antigenicity. Composite tissue and antigenic response.- Surgical technique of hand transplantation: The donor. The recipient. Differences between hand replantation and transplantation.- Immunosuppressive therapy: Induction and maintenance therapy. Side-effects. CMV infection and reactivation. Complications.- Functional recovery of transplanted hands: Rehabilitation and physiotherapy. Return of sensibility. Motor recovery - extrinsic and intrinsic muscles. Analysis of movement. The virtual glove and computer assisted assessment of results. Brain remodelling and plasticity of hand cortical representation. Functional magnetic resonance imaging. The sensory glove in preoperative conditioning and postoperative rehabilitation. Quality of life and hand transplantation.- Medico-legal implications: Informed consent. Insurances. Privacy issues in hand transplantation. Fingerprints.- Dermatologic analysis of the transplanted skin.- Limb rejection and monitoring: Histological evaluation and grading system. Acute and chronic rejection. Pharmacological treatment of rejection. Psychological issues in hand transplantation: Psychological profile of the patients. Body image and hand transplantation.- Tolerance and chimerism in hand transplantation.- Other composite tissue transplants: Knee transplantation. Larinx transplantation. Uterus transplantation.- Future directions: Face transplantation. Limb transplantation in congenital deformities. The International Registry of Hand and Composite Tissues Transplantation.- The complete bibliography on hand transplantation.- Images and video-clips of hand transplantation (DVD).