Partial Hand Transplant: Lessons Learned From Cadaveric Dissection Studies.

Area of Science:

• Regenerative Medicine
• Transplantation Surgery

Background:

• Vascularized composite allotransplantation (VCA) is expanding, necessitating evaluation of novel approaches for upper extremity reconstruction.
• A bilateral amputee with mid-forearm and metacarpal hand amputations presented a unique case for transplant consideration.

Observation:

• A "partial" hand transplant, preserving existing hand structures like the thumb, was proposed for the metacarpal amputation.
• Feasibility was assessed through fresh-frozen cadaver limb dissections, focusing on osteosynthesis, microvascular planning, and intrinsic muscle recovery.

Findings:

• Cadaveric dissections indicated that the proposed partial hand transplant approach was inferior to a conventional distal forearm transplant for this specific patient.
• Critical considerations for partial hand transplants include successful osteosynthesis, meticulous microvascular planning, and potential for intrinsic muscle function recovery.

Implications:

• The findings suggest that while innovative, partial hand transplantation may not be universally superior to established methods.
• This study highlights the complex practical, functional, and ethical considerations in selecting the optimal reconstructive strategy for complex upper extremity amputations.