The Institute for Plastic Surgery at Southern Illinois University (SIU) School of Medicine has launched the first clinical hand transplant program in Illinois for patients who have suffered from an amputation of their upper extremity.
This program, which would be the 11th in the nation, builds on a long-standing history of successful replantation, or re-attachment, of amputated digits, hands and upper extremities by the plastic and reconstructive hand surgeons at SIU, said Dr. Michael W. Neumeister, professor and chair of SIU’s Department of Surgery, The Elvin G. Zook Endowed Chair in Plastic Surgery and surgical director of the Hand Transplant Program at SIU School of Medicine.
The Memorial Medical Center Foundation provided a $2.8 million grant to establish the program. The grant is expected to cover the majority of costs for up to five patients over three years.
Between 6,000 and 10,000 upper extremity amputations occur each year in the United States, and over 1,200 soldiers have lost a limb as a result of explosions in Iraq and Afghanistan. It is estimated that over 1.3 million people in the United States currently have some form of amputation.
Since microsurgery was first initiated at SIU School of Medicine in the early 1980s, plastic surgery has reattached many amputated fingers and hands, Neumeister said. Unfortunately not all amputated limbs are salvageable and these patients are destined to live as amputees with or without the use of various prosthetics. Although prosthetics can be extremely useful they do have their limitations, costs and poor ability to provide sensation, he said.
The first long term successful hand transplant was performed in Louisville, Ky., in 1999. There have been nearly 100 hands subsequently transplanted worldwide, with an overall 5-year allograft survival rate of around 90 percent, compared to 75 percent in kidney transplants.
Hand transplantation can be technically very challenging and may last from 12 to 24 hours while bones, blood vessels, tendons, muscles, nerves and skin are meticulously repaired, Neumeister said. Patients subsequently require significant monitoring of their immunosuppressive (anti-rejection) medications as well as intense physical therapy to regain function of the transplanted upper extremity.
“Given the significant upper extremity trauma and number of amputations treated by SIU Plastic Surgery as well as the experience of transplantation at Memorial Medical Center, which has over 40 years of kidney/pancreas transplant experience, we are uniquely qualified and poised to offer hand transplantation within the Midwest,” Neumeister said.
Hand transplantation is an option for people who have lost one or both hands below the elbow and may even be beneficial for some above-elbow amputees. The goal is to restore hand function and sensation as well as a state of wholeness to the body.
It should only be considered by those who have attempted to use prosthetics but continue to have significant disability despite their use. Candidates for the procedure should also be in overall good health and be willing to comply with the medication and rehabilitation protocols after surgery.
“Because these patients will be receiving a deceased person’s tissue, they will be similar to other transplant patients and will require lifelong immunosuppression (anti-rejection) medications,” said Dr. Bradford West, medical director of SIU’s hand transplant program and chair of nephrology at Springfield Clinic. West also serves as medical director of the Alan G. Birtch, MD, Center for Pancreas and Kidney Transplant Program and Surgery Services at Memorial Medical Center.
“In contrast to other organ transplant patients, there is an added level of complexity to finding the right hand transplant donor since additional matching criteria are required, such as gender, ethnicity, skin color and tone, and size,” said West. “Despite these obstacles, there is a quality-of-life benefit that outweighs the risks for some patients who desire a higher level of functioning and a more natural look and feel.”
The Hand Transplant Program is a multidisciplinary endeavor that includes SIU School of Medicine, Memorial Transplant Services and Springfield Clinic Transplant Nephrology. Team members include plastic surgeons, transplant surgeons, orthopedic surgeons, transplant nephrology, infectious disease, pharmacology, psychiatry, pathology, anesthesia, radiology, neurology, ethics and hand therapy.
The success of the Hand Transplant Program will require appropriate amputee candidates and donors of the limb to be transplanted. All patients who receive a hand transplant will have undergone extensive testing and matching to try to prevent rejection, West said.
The overriding goal of the Hand Transplant Program is to return amputees back to their pre-amputation productive life without the need of a prosthetic limb.
The SIU Hand Transplant Program is a research study that has been approved by the Springfield Committee for Research Involving Human Subjects (SCRIHS) (IRB #12-811). Patients who meet the basic eligibility requirements and wish to be considered should contact the Clinical Research Coordinator at 1-855-SIU-HAND (1-855-748-4263) or firstname.lastname@example.org for an initial evaluation. See www.siumed.edu/handtransplant for more information.