The First Successful Combined Full Face and Bilateral Hand Transplant

Ramly, Elie P.; Alfonso, Allyson R.; Berman, Zoe P; Diep, Gustave K; Bass, Jonathan L; Catalano, Louis W.; Ceradini, Daniel J.; Choi, Mihye; Cohen, Oriana D; Flores, Roberto L.; Golas, Alyssa R.; Hacquebord, Jacques; Levine, Jamie P.; Saadeh, Pierre B.; Sharma, Shobhona; Staffenberg, David A.; Thanik, Vishal; Rojas, Allison; Bernstein, G. Leslie; Gelb, Bruce; Rodriguez, Eduardo D.

doi:10.1097/prs.0000000000009369

Cited by 15 publications

(18 citation statements)

References 41 publications

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“…12,17,20,54,66,70,75,104,105,110,115,120 Regarding social factors, the majority of centers (71%) specifically mentioned the need for a strong support system; yet, the support system was often poorly defined. 4,12,15,17,37,54,63,69,75,76,79,88,99,115,119,120 Psychological considerations were addressed by 28 programs, all of which required thorough psychiatric screening for major psychiatriccomorbidities. 12,16,17,19,20, 32,33,37,42,50,52-55, 64,66,69,73,75,77,89,90,99, 102,105,106,110,115,119 Patient Anatomy and Limb Deficiency Discussion over the nature of the defect was central in the articles reviewed.…”

Section: Demographic and Psychosocial Considerationsmentioning

confidence: 99%

“…1,2 First successfully performed in 1998, there are to date approximately 148 individuals that have undergone hand or distal upper extremity transplants, including one pediatric transplant and one combined face and double-hand transplant. [3][4][5] There are approximately 2.1 million individuals in the United States who live with upper limb loss. 6 Of the therapeutic options available that re-establish fine motor control for those with limb defects, HT is an attractive option because of its ability to successfully restore upper extremity form and function.…”

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confidence: 99%

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Vascularized Composite Allotransplantation of the Hand

et al. 2023

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Background Hand transplantation (HT) has emerged as an intervention of last resort for those who endured amputation or irreparable loss of upper extremity function. However, because of the considerable effort required for allograft management and the risks of lifelong immunosuppression, patient eligibility is critical to treatment success. Thus, the objective of this article is to investigate the reported eligibility criteria of HT centers globally. Methods A systematic review of the HT literature was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, using PubMed, Cochrane, Ovid/Medline, and Scopus. Program Web sites and clinicaltrials.gov entries were included where available. Results A total of 354 articles were reviewed, 101 of which met inclusion criteria. Furthermore, 10 patient-facing Web sites and 11 clinical trials were included. The most reported criteria related to the capacity to manage the allograft posttransplantation, including access to follow-up, insurance coverage, psychological stability, and history of medical compliance. Other factors related to the impact of immunosuppression, such as active pregnancy and patient immune status, were less emphasized. Conclusions Because of the novelty of the field, eligibility criteria continue to evolve. While there is consensus on certain eligibility factors, other criteria diverge between programs, and very few factors were considered absolute contraindications. As the popularity of the field continues to grow, we encourage the development of consensus evidence-based eligibility criteria.

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Section: Demographic and Psychosocial Considerationsmentioning

confidence: 99%

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confidence: 99%

Vascularized Composite Allotransplantation of the Hand

et al. 2023

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“…The world's first successful combined face and bilateral hand transplant utilized 3DP technology. Prefabricated 3D‐printed cutting guides and custom splints were employed for donor and recipient osteotomies and intraoperative optimization of tendon repair, respectively 108,109 . Additionally, to aid in identification and repair of the 21 tendons, 6 vessels, and 3 nerves per hand, 3D‐printed, sterilizable labeled tags were used intraoperatively 109 .…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…Prefabricated 3D‐printed cutting guides and custom splints were employed for donor and recipient osteotomies and intraoperative optimization of tendon repair, respectively 108,109 . Additionally, to aid in identification and repair of the 21 tendons, 6 vessels, and 3 nerves per hand, 3D‐printed, sterilizable labeled tags were used intraoperatively 109 . This one case alone highlights a range of intraoperative uses for 3D‐printed applications and technologies.…”

Section: Clinical Applicationsmentioning

confidence: 99%

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The presence of 3D printing in orthopedics: A clinical and material review

Colon

Nayak

Parente

et al. 2022

Journal Orthopaedic Research

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The field of additive manufacturing, 3D printing (3DP), has experienced an exponential growth over the past four decades, in part due to increased accessibility.Developments including computer-aided design and manufacturing, incorporation of more versatile materials, and improved printing techniques/equipment have stimulated growth of 3DP technologies within various industries, but most specifically the medical field. Alternatives to metals including ceramics and polymers have been garnering popularity due to their resorbable properties and physiologic similarity to extracellular matrix. 3DP has the capacity to utilize an assortment of materials and printing techniques for a multitude of indications, each with their own associated benefits. Within the field of medicine, advances in medical imaging have facilitated the integration of 3DP. In particular, the field of orthopedics has been one of the earliest medical specialties to implement 3DP. Current indications include education for patients, providers, and trainees, in addition to surgical planning. Moreover, further possibilities within orthopedic surgery continue to be explored, including the development of patient-specific implants. This review aims to highlight the use of current 3DP technology and materials by the orthopedic community, and includes comments on current trends and future direction(s) within the field.

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Combined Whole Eye and Face Transplant

Ceradini,

Tran,

Dedania

et al. 2024

JAMA

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ImportanceCatastrophic facial injury with globe loss remains a formidable clinical problem with no previous reports of reconstruction by whole eye or combined whole eye and facial transplant.ObjectiveTo develop a microsurgical strategy for combined whole eye and facial transplant and describe the clinical findings during the first year following transplant.Design, Setting, and ParticipantA 46-year-old man who sustained a high-voltage electrical injury with catastrophic tissue loss to his face and left globe underwent combined whole eye and face transplant using personalized surgical devices and a novel microsurgical strategy at a specialized center for vascularized composite allotransplantation.Main Outcomes and MeasuresReperfusion and viability of the whole eye and facial allografts, retinal function, and incidence of acute rejection.ResultsThe patient underwent a combined whole eye and face transplant from an immunologically compatible donor with primary optic nerve coaptation and conventional postoperative immunosuppression. Globe and retinal perfusion were maintained throughout the immediate postoperative period, evidenced by fluorescein angiography. Optical coherence tomography demonstrated atrophy of inner retinal layers and attenuation and disruption of the ellipsoid zone. Serial electroretinography confirmed retinal responses to light in the transplanted eye. Using structural and functional magnetic resonance imaging, the integrity of the transplanted visual pathways and potential occipital cortical response to light stimulation of the transplanted eye was demonstrated. At 1 year post transplant (postoperative day 366), there was no perception of light in the transplanted eye.Conclusions and RelevanceThis is the first report of whole eye transplant combined with facial transplant, demonstrating allograft survival including rejection-free graft survival and electroretinographic measurements indicating retinal response to light stimuli. These data highlight the potential for clinical allotransplantation for globe loss.

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The First Successful Combined Full Face and Bilateral Hand Transplant

Abstract: This trial is registered under the name "Craniomaxillofacial and Upper Extremity Allotransplantation," Clinical Trials. gov identification number NCT04057638 (https://clinicaltrials.gov/ct2/show/NCT04057638).

Cited by 15 publications

References 41 publications

Vascularized Composite Allotransplantation of the Hand

Vascularized Composite Allotransplantation of the Hand

The presence of 3D printing in orthopedics: A clinical and material review

Combined Whole Eye and Face Transplant

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