Replantation versus transplantation: Where do we stand?

Area of Science:

• Reconstructive Microsurgery
• Transplantation Immunology
• Trauma Surgery

Background:

• Traumatic amputations present ongoing challenges in extremity care, often resulting in lasting disability.
• Replantation and advanced prosthetics do not always restore full function, leaving a need for alternative solutions.
• Upper extremity loss significantly impacts patient quality of life and functional independence.

Purpose of the Study:

• To provide hand and reconstructive surgeons with an overview of current upper extremity transplantation.
• To equip surgeons to better counsel amputee patients on transplantation as a treatment option.
• To highlight the potential benefits and considerations of hand transplantation for limb loss.

Main Methods:

• Comprehensive review of current literature on upper extremity transplantation and replantation.
• Analysis of data from the international registry on hand and composite tissue transplantation.
• Synthesis of outcomes for both replantation and transplantation procedures.

Main Results:

• Sensory and functional outcomes following replantation and transplantation are comparable.
• Complications associated with immunosuppression in hand transplantation mirror those in other solid organ transplants.
• The financial cost of hand transplantation is substantial but comparable to the long-term expenses associated with prosthetic use.

Conclusions:

• Hand transplantation can substantially enhance patient-reported outcomes and quality of life in carefully selected and well-informed individuals.
• Immunosuppression risks are a critical factor, necessitating thorough patient education and consideration.
• Despite challenges, hand transplantation represents a significant advancement in managing upper extremity loss.