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Replantation versus transplantation: Where do we stand?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Despite advances in extremity trauma care and reconstructive microsurgery, management of the traumatic amputations remains a challenge. The majority of patients will forever experience some level of disability even with replantation or advanced prosthetics. The goal of this article is to familiarize hand and reconstructive surgeons with the current state of upper extremity transplantation, so they better can educate their amputee patients regarding this as an option following limb loss.

Methods

Current literature, in addition to the international registry on hand and composite tissue transplantation, was reviewed to assemble a summary of outcomes in upper extremity replantation and transplantation.

Results

Sensory and functional outcomes of replantation and transplantation are comparable. Reported complications of immunosuppression are similar to those of other solid organ transplants. The financial cost of hand transplantation is high, but comparable to the lifetime cost of prosthesis use.

Conclusion

While the risk of immunosuppression is a serious consideration for patients pursuing hand transplantation, in the well-selected and informed patient, hand transplantation can dramatically improve patient reported to outcomes and quality of life.

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Correspondence to L. Scott Levin.

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This is a review article and did not require institutional approval for completion.

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The lead author obtained consent for use of photographs and videos from included patients.

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Video 1: 35-year-old patient 6 years out from bilateral hand transplant in this photo and now 7 years out form her transplant. She is the first bilateral hand transplant patient to have a baby post-transplant. She is able to hold and change her baby's diaper with her transplanted hands, which has more meaning to her than she could achieve with a prosthesis. Photo and video content provided by senior author LS Levin and permission for publication has been obtained from patient (MP4 5658 KB)

Video 2: 48-year-old patient 4 years out from bilateral hand transplant in this photo. Her ability to drive gives her independence that she has not had in many years. Video content provided by senior author LS Levin and permission for publication has been obtained from patient. (MP4 6555 KB)

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Janes, L.E., McAndrew, C. & Levin, L.S. Replantation versus transplantation: Where do we stand?. Eur J Orthop Surg Traumatol (2023). https://doi.org/10.1007/s00590-023-03737-1

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