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All hands on deck: Hand replantation versus transplantation
John Heineman1, Ericka M Bueno2, Harriet Kiwanuka2
1Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
SAGE Open Medicine
|June 16, 2020
Summary
Hand replantation is preferred after amputation. If replantation fails or isn't possible, hand transplantation offers comparable outcomes. Patient commitment and realistic expectations are crucial for successful hand reconstruction.
Area of Science:
- Orthopedics
- Reconstructive Surgery
- Microsurgery
Background:
- Hands are vital for daily activities and identity.
- Approximately 41,000 individuals in the U.S. live with upper limb loss.
- Limb transplantation outcomes are informed by replantation experience.
Purpose of the Study:
- Systematically review hand replantation and transplantation outcomes.
- Identify determinants of success for both procedures.
- Summarize current data on hand reconstruction outcomes.
Main Methods:
- Systematic review following PRISMA guidelines.
- PubMed searches from 1964-2013 for English articles.
- Analysis of 53 articles on wrist/forearm complete amputations.
Main Results:
- Comparison of pre-operative, surgical, and post-operative factors.
- Outcomes assessed: motor function, sensation, cosmesis, patient satisfaction, adverse events, cost, and overall function.
- Data heterogeneity limits direct comparison; patient expectations and commitment are key.
Conclusions:
- Hand replantation is the primary choice for acute amputations.
- Hand transplantation provides comparable outcomes when replantation is not feasible.
- Optimal results require patient commitment, realistic expectations, and surgeon expertise.
