Hand Transplant Surgery - Benefits and Risks

Introduction:

Hand transplant surgery is done on people who have either one or both hands amputated. It is a complicated procedure in which bones are fixed, and the major arteries, veins, nerves, tendons, and skin are repaired. In this procedure, one or two donor hands and a portion of the forearms are received from a diseased person. This surgery might take around eight to 12 hours. It is done by a team of highly qualified and experienced surgeons.

What Is Hand Transplant Surgery?

Hand transplant surgery is a procedure done in people who have one or both of their hands amputated. In this procedure, a donor's hand is attached to the receiver’s by a team of experienced surgeons. The hand was received from a diseased donor. This surgery can be a life-changing procedure. An important element for the procedure's success is the selection of the limb from the donor. In addition to meeting the criteria for selecting other organs, care is taken to match the donor's hand size, skin color and tone, gender, and ethnicity to that of the recipient. Similar to any other type of transplantation, like heart, liver, lung, kidney, or pancreas, patients who undergo a limb transplant must take immunosuppressive medications to prevent rejection of the graft. Patients also undergo a rehabilitation regimen to restore the function of the transplanted hand. Rehabilitation therapy is frequently started 48 hours after surgery and is critical for the functional success of the procedure. The patient also undergoes periodic biopsies and laboratory examinations.

Why Is Hand Transplant Surgery Performed?

Hand transplants are challenging compared to other transplant procedures. The loss of a hand or hands is not a life-threatening situation. Therefore, the decision to get a hand transplant is crucial and is to be decided by the patient and their family. A few people who have lost their hand or even an entire arm live and function well with the help of prosthetics. However, if a prosthesis is unsuccessful, transplantation of a new hand or arm might be thoughtful. In certain cases where the injury of a patient is severe and is not addressed with traditional reconstructive surgery, frequent transplantation is advised by the doctors. Some of the criteria that are to be fulfilled for transplantation are:

• In a patient of 18 to 69 years old.

• The patient must have good overall health.

• One should be able to tolerate immunosuppressive drugs.

• Free of cancer for the past five years.

• Patients should be free of major infections such as hepatitis or Human Immunodeficiency Virus (HIV).

How Is Hand Transplant Surgery Performed?

Hand transplant surgery is a complicated procedure that involves bone fixation, reattachment of arteries and veins, and repair of the tendons and nerves. This procedure lasts for around 8 to 12 hours or might take longer. A team of experienced surgeons performs it. The steps involved in this procedure are:

• A donor's hand is needed to transplant a hand that was obtained from a deceased donor.

• This hand is to be attached to the receiver’s body.

• Intensive testing is done after the reattachment of blood vessels to ensure their working.

• After placement, proper bone fixation, reattachment of arteries and veins, and repairing of the tendons and nerves are required.

• Further complications are checked.

The most crucial part of the recovery process, in terms of having the best long-term function, is nerve regeneration, which begins after the nerves are surgically connected between the recipient and the donated hand or arm.

For the healing of a nerve, it needs to be reconnected properly at the site of injury. Once this is achieved, nerve fibers start growing inside the connected nerves at the site of the nerve repairs, away from the body and towards the new body part, at a rate of one inch per month. The new limb should regain nerve signals approximately within three to 18 months, depending on the part of the body. However, the results are never guaranteed.

What Are the Benefits of Hand Transplantation?

• Improved Functionality – A hand or arm transplantation procedure can restore the physical functionality of the hands or arms of the patient. Daily activities like eating, drinking, brushing teeth, shaving, picking up something, writing, etc get improved by this procedure.

• Restoration of Appearance - The hand and arm transplantation procedure can restore a near-to-normal appearance of the hand of the patient. This helps the patients regain confidence to return to their earlier lifestyle and move publicly.

What Are the Risks of Hand Transplantation?

As with any other organ transplantation, the fields of greatest concern are:

• Preventing Rejection: Rejection can be of two types, namely acute and chronic. Acute rejection is when the body considers the transplanted limb a foreign object, and the immune system fights against it. Rejection often presents on the skin first as a rash or blotchiness. This typically happens within the first couple of months. Chronic rejection is a long-term that takes place over years and can eventually lead to failure. However, if the patient follows the prescribed immunosuppressant treatment, there has been evidence that good long-term outcomes can be achieved after a hand transplant.

• Pain and Discomfort: As compared to the other alternatives, like doing nothing or using a prosthesis, the patient undergoing hand or arm transplantation feels more post-operative pain and discomfort. Longer hospital stays might be required after this surgery.

• Psychological Issues: As the hands and arms are used continuously during the entire day, there is a concern that the patient might face difficulty in adjusting to the new limbs.

• Functionality Issues: It might be possible that after upper extremity transplantation, the patient will observe deficits in hand or arm motion, and thus, the functionality of the transplanted hand or arm gets limited.

Conclusion:

Hand translate surgery is performed in cases where other methods, like prostheses, etc., are unsatisfactory for the patient. Hand transplant surgery has benefits and risks like any other kind of surgery. It is esthetically good, helps the patient boost their confidence and move publicly, helps them perform day-to-day chores, etc. While some risks can be associated with it, like transplant rejection, infection, etc.