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Transplant

 Hand

Learn More

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Preparation

Once an appropriate donor is found for the patient, the patient will immediately be called to the hospital. The patient is admitted for transplantation, and final preparatory tests such as an EKG, chest X-ray, and blood analysis is performed. Pre-operative medications, including the first dose of anti-rejection medication, are initiated.

Procedure

During the transplant surgery, general anesthesia is administered to put the patient to sleep. Prior to the procedure, the patient will receive regional block to help control pain after the surgery. Intravenous access will include lines being placed in either the neck or groin region by an anesthesia provider prior to surgery.

Hand transplantation involves the placement of the donor hands onto the recipients' amputation stumps. There are 2-4 surgical teams comprised of reconstructive hand and microsurgeons who prepare the donor and recipient hands. Once this is accomplished, the following structures are reconstructed in order to restore the hands:

  • Forearm bones (radius and ulna)
  • Tendons (flex and extend the wrist, fingers, and thumb)
  • Blood vessels (arteries and veins)
  • Nerves
  • Skin

On average, the transplant surgery may last between 10-18 hours. This is a lengthy procedure and the patient receives blood products and fluids throughout the surgery. Drains may be placed to help collect extra fluid and help with healing. A probe will be placed around the artery or vein to ensure blood flow is adequate throughout the vessels of the newly transplanted hand.

Recovery

After the procedure, the patient goes to the intensive care unit for up to five days. Occupational therapy and physical therapy evaluates the patient, with hand therapy sessions to begin within 2-3 days after surgery. The patient is then transferred to the transplant floor, where he or she stays for about two weeks. The total length of stay is about 21 days. Procedures that may occur in the intensive care unit and floor include, but are not limited to, skin biopsies, bedside vascular ultrasounds, and daily hand splint and dressing changes.

The patient is expected to follow up with both the transplant clinic and occupational therapy after leaving the hospital. The transplant patient takes medications to suppress the immune system in order to prevent rejection. The transplant team monitors the patient for any complications or signs of rejection. Over time, the team will attempt to decrease the dosage and number of medications to minimize the potential for drug related side effects.

After the transplant, the patient must learn how to use the new hand(s). It is critical that the patient actively participates in hand therapy daily for at least five days a week. This is to optimize the function of the newly transplanted hands. The transplant patient is followed closely by the hand transplant team in order to ensure that the graft is functioning well, any rejection is treated, and that the overall needs are being met. The primary goal of the team is the patient's safety and restoration.

For more information, please view The Hand Transplant Journey.

Hand Therapy

After transplant, the patient is expected to undergo intensive hand therapy. This consists of daily supervised exercises and homework on the weekends. As the patient regains more function and becomes more independent, the therapy sessions will be less frequent and the simple acts of daily living will constitute the bulk of the rehabilitation.

For more information on what to expect related to hand therapy, please view Therapy Following Hand Transplantation.

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