Invited Comment: Vascularized composite allotransplantation: An update on medical and surgical progress and remaining challenges

Kay, Simon M. D.; Wilks, Daniel J.

doi:10.1016/j.bjps.2013.04.065

Cited by 10 publications

(7 citation statements)

References 6 publications

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“…However, an overwhelming majority (71 %) of surgeons in the survey of Mathes et al believe that hand transplantation does produce a benefit when performed on a properly selected patient [ 29 ]. Although requested by experts of this field, surprisingly, a comparison of hand function of transplanted hands with up-to-date prosthetic hands at a similar amputation level has not yet been performed [ 41 ]. The largest trial comparing hand function of prosthesis and replants was performed by Graham et al [ 42 ].…”

Section: Indicationsmentioning

confidence: 99%

Hand Transplantation Versus Hand Prosthetics: Pros and Cons

et al. 2016

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Composite tissue transplantation and new developments in the field of prosthetics have opened new frontiers in the restoration of function among upper limb amputees. It is now possible to restore hand function in affected patients; however, the indications, advantages, and limitations for either hand transplantation or prosthetic fitting must be carefully considered depending on the level and extent of the limb loss. Hand transplantation allows comprehensive hand function to be restored, yet composite tissue transplantation comes with disadvantages, making this method a controversial topic in the hand surgical community. Alternatively, prosthetic limb replacement represents the standard of care for upper limb amputees, but results in the known limitations of function, sensation, and usage. The indication for hand transplantation or prosthetic fitting strongly depends on the level of amputation, as well as on the extent (unilateral/bilateral) of the amputation. In this review, we discuss the advantages and disadvantages of hand transplantation and prosthetic replacement for upper limb amputees in general, as well as in regard to the different levels of amputation.

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Section: Indicationsmentioning

confidence: 99%

Hand Transplantation Versus Hand Prosthetics: Pros and Cons

et al. 2016

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“…[21] Our results provide clinicians with a practical picture of the advantages, disadvantages and most importantly, functional and psychosocial outcomes of the two procedures for patients as recommended by experts in this field. [25]…”

Section: Discussionmentioning

confidence: 99%

“…[21–24] The need for such an investigation has been highlighted by the specialist community. [25] Presented here is a multi-center cohort study comparing the functional outcomes of patients whose hands were reconstructed either by means of transplantation or prosthetic fitting from three different centers in Austria and Poland.…”

Section: Introductionmentioning

confidence: 99%

Functional and Psychosocial Outcomes of Hand Transplantation Compared with Prosthetic Fitting in Below-Elbow Amputees: A Multicenter Cohort Study

et al. 2016

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BackgroundHand-transplantation and improvements in the field of prostheses opened new frontiers in restoring hand function in below-elbow amputees. Both concepts aim at restoring reliable hand function, however, the indications, advantages and limitations for each treatment must be carefully considered depending on level and extent of amputation. Here we report our findings of a multi-center cohort study comparing hand function and quality-of-life of people with transplanted versus prosthetic hands.MethodsHand function in amputees with either transplant or prostheses was tested with Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP) and the Disabilities of the Arm, Shoulder and Hand measure (DASH). Quality-of-life was compared with the Short-Form 36 (SF-36).ResultsTransplanted patients (n = 5) achieved a mean ARAT score of 40.86 ± 8.07 and an average SHAP score of 75.00 ± 11.06. Prosthetic patients (n = 7) achieved a mean ARAT score of 39.00 ± 3.61 and an average SHAP score of 75.43 ± 10.81. There was no significant difference between transplanted and prosthetic hands in ARAT, SHAP or DASH. While quality-of-life metrics were equivocal for four scales of the SF-36, transplanted patients reported significantly higher scores in “role-physical” (p = 0.006), “vitality” (p = 0.008), “role-emotional” (p = 0.035) and “mental-health” (p = 0.003).ConclusionsThe indications for hand transplantation or prosthetic fitting in below-elbow amputees require careful consideration. As functional outcomes were not significantly different between groups, patient’s best interests and the route of least harm should guide treatment. Due to the immunosuppressive side-effects, the indication for allotransplantation must still be restrictive, the best being bilateral amputees.

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“…31 According to United Kingdom hand transplant surgeons Simon Kay and Daniel Wilks, "Of the large number of [hand and face] transplants completed now, outcome data of value is to be found in few." 32…”

Section: Gaps In the Literature On Htx And Vcamentioning

confidence: 99%

What's Missing in Our Thinking About Quality of Life in VCA?

Herrington

2019

AMA Journal of Ethics

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Drawing on the principles of respect for autonomy and beneficence, many scholars have argued that despite significant drawbacks of immunosuppression and surgery, vascularized composite allotransplantation (VCA), such as hand and face transplantation, has the potential to enhance the lives of patients who meet appropriate criteria and are well supported. This article provides a brief overview of the literature on VCA with a focus on hand transplantation (HTx) and offers a critique of the lack of empirical data on HTx patients' perspectives. Quality of Life in Hand Transplants Within a few years after the publication of the first journal articles arguing for the ethical and scientific viability of hand transplantation in the modern era of immunosuppression, 1,2,3 hand transplantation (HTx) and other forms of vascularized composite allotransplantation (VCA) had become technically possible, 4,5,6 and they now are viewed as beneficial for properly selected and supported recipients. 7,8,9,10 Because reconstructive transplantation, such as hand and face transplantation, does not afford the lifesaving or life-extending benefits that have so far characterized transplant medicine, the permissibility of VCA resides in the potential of these transplants to enhance recipients' subjective quality of life (QoL) for as long as they have their allograft. Realizing potential gains in QoL is complicated, however, by the burdens of lifelong immunosuppression to prevent graft rejection and loss, which can also potentially limit longevity.

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Invited Comment: Vascularized composite allotransplantation: An update on medical and surgical progress and remaining challenges

Cited by 10 publications

References 6 publications

Hand Transplantation Versus Hand Prosthetics: Pros and Cons

Hand Transplantation Versus Hand Prosthetics: Pros and Cons

Functional and Psychosocial Outcomes of Hand Transplantation Compared with Prosthetic Fitting in Below-Elbow Amputees: A Multicenter Cohort Study

What's Missing in Our Thinking About Quality of Life in VCA?

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