Rehabilitation Following Hand Transplantation

Bueno, Ericka M.; Benjamin, Marie-Jose; Sisk, Geoffroy C.; Sampson, Christian E.; Carty, Matthew J.; Pribaz, Julian J.; Pomahac, Bohdan; Talbot, Simon G.

doi:10.1007/s11552-013-9568-8

Cited by 38 publications

(34 citation statements)

References 27 publications

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“…Rehabilitative motion is a cornerstone during the postoperative period, with motion initiated as early as postoperative day 1. 8 Barring early complications, standard management by the senior author of this case report (S.M.W.) is the establishment of strict early motion protocol for all replantation patients within the first 3 postoperative days.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Early Motion Protocol for Total Hand Replantation: 1- and 2-Year Postoperative Results

Harrison

Anderson

Wimalawansa

2020

Journal of Hand and Microsurgery

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Introduction We review the benefits of early motion protocols following replantation of a total right hand amputation at 1 and 2 years after replantation, and provide recommendations for postoperative management. Materials and Methods Replantation of the entire right hand in zone-4 was performed and supported by rigid external fixation spanning the forearm and hand. An early active “place-and-hold” motion protocol was initiated within the first 3 postoperative days. Metacarpophalangeal joint extensors were tethered by the pins, limiting full excursion. This resulted in stiffness and extensor adhesions that required a staged extensor tenolysis; however, all joints remained supple. The early motion protocol prevented the need for significant flexor tenolysis and joint releases. Results Early motion rehabilitation protocols can produce very successful results in complex replantation. The enhanced stability afforded by external fixation of the wrist allowed us to perform aggressive early rehabilitation. Conclusion This case highlights the benefits of early active motion (limiting the need for complex joint and flexor tendon releases) and demonstrates the degree of extensor adhesions caused by even minor extensor tendon tethering. This aggressive rehabilitation approach can produce excellent range of motion, and likely limit the need for secondary tenolysis and joint release procedures.

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Section: Discussionmentioning

confidence: 99%

Outcome of Early Motion Protocol for Total Hand Replantation: 1- and 2-Year Postoperative Results

Harrison

Anderson

Wimalawansa

2020

Journal of Hand and Microsurgery

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“…Functional outcomes following hand and upper extremity transplantation have demonstrated a large degree of variability and depend upon a number of factors . However, the amount of time needed for graft reinnervation to occur is known to be the most important factor predicting functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike solid organ transplantation, surgical outcomes after VCA depend on peripheral nerve regeneration . Following transplantation, the recipient's axons must regenerate into the graft so as to innervate the transplanted composite tissues.…”

Section: Introductionmentioning

confidence: 99%

A Novel Rodent Orthotopic Forelimb Transplantation Model That Allows for Reliable Assessment of Functional Recovery Resulting From Nerve Regeneration

Kern

Budihardjo

Mermulla

et al. 2017

American Journal of Transplantation

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Improved nerve regeneration and functional outcomes would greatly enhance the utility of vascularized composite allotransplantation (VCA) such as hand and upper extremity transplantation. However, research aimed at achieving this goal has been limited by the lack of a functional VCA animal model. We have developed a novel rat midhumeral forelimb transplant model that allows for the characterization of upper extremity functional recovery following transplantation. At the final end point of 12 weeks, we found that animals with forelimb transplantation including median, ulnar and radial nerve coaptation demonstrated significantly improved grip strength and forelimb function as compared to forelimb transplantation without nerve approximation (grip strength: 1.71N ± 0.57 vs. no appreciable recovery; IBB scale: 2.6 ± 0.7? vs. 0.8 ± 0.40; p = 0.0005), and similar recovery to nerve transection-and-repair only (grip strength: 1.71N ± 0.57 vs. 2.03 ± 0.42.6; IBB scale: 2.6 ± 0.7 vs. 2.8 ± 0.8; p = ns). Moreover, all forelimb transplant animals with nerve coaptation displayed robust axonal regeneration with myelination and reduced flexor muscle atrophy when compared to forelimb transplant animals without nerve coaptation. In conclusion, this is the first VCA small-animal model that allows for reliable and reproducible measurement of behavioral functional recovery in addition to histologic evaluation of nerve regeneration and graft reinnervation.

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“…Nerve regeneration might prolong the need for aiding C with activities of daily living. 23,24 This possibility, combined with the strenuous rehabilitative regimen, 25 would hinder N's ability to participate in social activities-potentially straining her relationship with C. 26 Given these burdens, consultation must consider the needs of nonprofessional caregivers like N to be an extension of the patient's needs via their social relationship.…”

Section: Understanding the Caregiver Rolementioning

confidence: 99%

Should a Caregiver's QoL Be Considered in Decisions About Whether a Patient Has an Experimental Double-Hand Transplant?

Dorante¹,

Devine

Talbot

2019

AMA Journal of Ethics

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A goal of hand and upper extremity transplantation is to return motor and sensory function to an amputee. Given the integral roles of one's hands in activities of daily living and social interaction, however, restoring psychosocial well-being should also be a priority. Based on the authors' experience, double-hand transplantation success depends significantly on strong social support, physical rehabilitation, medication adherence, and social integration. Because caregiving is demanding, tasks should be distributed among members of a patient's family and social network. This article analyzes how to respond to an overwhelmed caregiver by drawing on solid organ transplant literature about caregiver fatigue. CaseC is a quadrilateral amputee who lives with her partner, N. After 2 years of working with prosthetics and outfitting their apartment with assistive devices, N and C have a life together they enjoy.

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Rehabilitation Following Hand Transplantation

Cited by 38 publications

References 27 publications

Outcome of Early Motion Protocol for Total Hand Replantation: 1- and 2-Year Postoperative Results

Outcome of Early Motion Protocol for Total Hand Replantation: 1- and 2-Year Postoperative Results

A Novel Rodent Orthotopic Forelimb Transplantation Model That Allows for Reliable Assessment of Functional Recovery Resulting From Nerve Regeneration

Should a Caregiver's QoL Be Considered in Decisions About Whether a Patient Has an Experimental Double-Hand Transplant?

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