Hand Transplantation

477 Pages·2007·10.846 MB·English

by  Bruce W. Conolly, Mario Benanzio (auth.), Marco Lanzetta, Jean-Michel Dubernard, Palmina Petruzzo (eds.)

Hand Transplantation
Marco Lanzetta · Jean-Michel Dubernard (Editors)
Palmina Petruzzo (Assistant Editor)
Hand
Transplantation
1 3
Editors
MARCOLANZETTA
Director,Italian Institute of Hand Surgery
Monza,Milan,Italy
Adjunct Professor,University of Canberra,Australia
President,International Hand and
Composite Tissue Allograft Society
JEAN-MICHELDUBERNARD
Department of Transplantation
Édouard Herriot Hospital
Lyon,France
Assistant Editor
PALMINAPETRUZZO
Department of Transplantation
Édouard Herriot Hospital
Lyon,France
Department of Surgery
University of Cagliari,Italy
Library ofCongress Control Number:2006928862
ISBN-10 88-470-0373-3 Springer Milan Berlin Heidelberg New York
ISBN-13 978-88-470-0373-6 Springer Milan Berlin Heidelberg New York
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“to my wife Mariagrazia and
my sons Matteo,Michael and Pietro,
for sharing all my dreams,
and
to Valter,Gianni,Domenico,heroic patients,
for their trust in me and my trust in them”
Marco Lanzetta
“to my grand children
Louis,Hugues,Alexis,Émilie,Céline,Elsa ...
dreams might come true”
Jean-Michel Dubernard
Preface
The story of this book is quite simple: after the no criteria as to how the disability of these
first few hand transplants,we felt the need to have patients would be revaluated after the hand trans-
regular meetings so that our clinical experiences plant.
would be beneficially shared and serve as a basis Clinically, the most challenging issues have
to draw some guidelines for the future. In so been identifying the best immunosuppressive
doing, we soon realised that a huge amount of drug regime and understanding how acute rejec-
original clinical data and information was becom- tion develops and how to reverse it.Use ofan addi-
ing available as we were proceeding with our oper- tional distant skin island allograft resulted in bet-
ations and closely following our patients’progress ter rejection monitoring,at the same time avoid-
and functional outcomes.Some ofthese data were ing the need to take multiple biopsies from the
reported in scientific articles,but to group them in hand. Nerve regrowth and excellent
a comprehensive book seemed the best way to sensibility/motor recovery was one of the most
provide a complete review of this pioneering important results in hand transplantation, and
work. leading experts in peripheral nerve regeneration
Since starting our hand transplantation pro- suggest a scientific explanation.Rehabilitation of
grammes,we often felt we were exploring a new the transplanted hand has been very demanding
area of surgery without the possibility or comfort for both therapists and patients,and specific pro-
of referring to already published work to support tocols had to be implemented.
our own decisions.Indeed,some aspects of hand As the hand is only one ofthe composite tissues
transplantation required prompt decisions based currently transplanted in order to correct disabilities
solely on personal interpretation of presenting or deformities,we include chapters on all the other
clinical scenarios. New techniques were intro- types of non-life-saving allografts,including the
duced to address different needs, such as the face,knee joint,uterus,abdominal wall and larynx.
analysis of brain remodeling using functional We are honoured to have such a great number
magnetic resonance imaging or the use ofa senso- of internationally renowned personalities share
ry glove to precondition the patient or accelerate their experience and knowledge in this book;their
the recovery ofsensibility.Original work included contributions have made it the most complete
creation of a specific consent form for patients, work available on hand and other composite tis-
psychological tests for candidates and a compre- sue allografts. We hope it will serve as a useful
hensive scoring system for assessing clinical out- guide for those desiring to launch their own com-
come.There was the need to establish a grading posite tissue transplantation programmes or to
system to evaluate acute skin rejection and clear those who simply wish to read about the current
criteria to select ideal candidates. From a legal state ofthe art ofthis new and exciting field.
point of view, there were no criteria for dealing
with persons carrying two different sets offinger- Marco Lanzetta
prints.From an insurance perspective,there were Jean-Michel Dubernard
Contents
1.HISTORICAL REMARKS
1a.Cosmas and Damian revisited
B.W.CONOLLY,M.BENANZIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1b.Hand Transplantation as an Evolution ofMicrosurgery:A Logical Step Towards Better
Reconstructive Options
M.LANZETTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.EXPERIMENTAL LIMB TRANSPLANTATION
2a.Hind-Limb Transplantation in the Rat:Surgical Technique,Anaesthesia and Early
Postoperative Management
M.MOLITOR,T.KANATANI,M.LANZETTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2b.Indefinite Survival and Functional Recovery ofLimb Allografts in Rodents
T.KANATANI,M.LANZETTA,G.A.BISHOP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
2c.Induction ofHigh-Level Chimerism in Composite Tissue Transplants
K.MURAMATSU,K.DOI,H.TANAKA,T.TAGUCHI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
2d.Simultaneous Vascularised Bone Marrow Transplantation to Promote Acceptance ofLimb Allografts
M.LANZETTA,A.KUBITSKIY,G.A.BISHOP,J.LI,G.W.MCCAUGHAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
2e.Experimental Approaches to Composite Tissue Allograft Transplants
M.SIEMIONOW,Y.KULAHCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
2f.A Review ofCurrent Strategies to Achieve Tolerance in Animal Models
D.ZAMFIRESCU,I.LASCAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
2g.The History ofExperimental Hand Transplantation in Primates
R.K.DANIEL,K.A.BRENNER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
2h.Hand Transplantation in Monkeys:Technical Details and Immunological Aspects
S.E.R.HOVIUS,H.M.ZUIJDENDORP,J.J.P.D.STEVENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
X Contents
3.ETHICS AND MEDICO-LEGAL IMPLICATIONS
3a.Ethical Aspects ofNon Life-Saving Allografts with Special Regard to the Hand
D.SICARD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
3b.Ethical Issues ofOrgan Transplantation in Non-Life-Saving Situations
M.COZZOLI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
3c.Informed Consent,Medico-Legal Implications,Public and Private Insurance Issues
and Quantification ofDisability in Hand Transplantation
U.GENOVESE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
3d.Living with Two Different Fingerprints:Legal Implications and Identification Issues
G.MENNA,P.SCARPIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
4.ORGANIZATION OF HAND TRANSPLANTATION
4a.Selection ofCandidates and Waiting List,Dealing with the Media and the Public,Setting Up a Pilot
Study,Clinical Trial Organization,StaffRequisites for Hand Transplantation:The Lyon Experience
J.M.DUBERNARD,X.MARTIN,P.PETRUZZO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
4b.Selection ofCandidates and Waiting List,Dealing with the Media and the Public,Setting Up a Pilot
Study,Clinical Trial Organization,StaffRequisites for Hand Transplantation:The Milan Experience
M.LANZETTA,R.NOLLI,I.RADAELLI,R.COLETTI,F.PALEARI,A.CAPPELLINI,F.UGGERI,
M.SCALAMOGNA,A.RAMPA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
4c.Selection ofCandidates and Waiting List,Dealing with the Media and the Public,Setting Up a Pilot
Study,Clinical Trial Organization,StaffRequisites for Hand Transplantation:The Innsbruck Experience
G.BRANDACHER,S.SCHNEEBERGER,R.MARGREITER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
4d.Selection ofCandidates and Waiting List,Dealing with the Media and the Public,Setting Up a Pilot
Study,Clinical Trial Organization,StaffRequisites for Hand Transplantation:The Brussels Experience
F.SCHUIND,C.VANHOLDER,D.ABRAMOWICZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
4e.Patient Management and Follow-Up
P.PETRUZZO,S.LUCCHINA,C.DEZZA,G.LUCCHINI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
5.SURGICAL TECHNIQUE OF HAND TRANSPLANTATION
5a.Instruments,Sutures and Needles for Hand Transplantation
G.LUCCHINI,F.MAGNI,M.LANZETTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
5b.Anaesthetic Management
G.VITALE,E.MARTINEZ,P.MAISANO,L.DEMARCHI,M.SAINI,G.BELLANI . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
5c.Harvesting the Hand
M.LANZETTA,R.NOLLI,L.BETTELLA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
5d.Preparing the Recipient
A.GAZARIAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Contents XI
5e.Technical and Surgical Details ofHand Transplantation
M.NINKOVIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
5f.Hand Replantation and Transplantation:More Differences than Similarities
M.LANZETTA,R.NOLLI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
6.IMMUNOLOGY OF HAND TRANSPLANTATION
Current Concepts
O.THAUNAT,E.MORELON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
7.IMMUNOSUPPRESSIVE THERAPY
7a.Induction and Maintenance Therapy
P.PETRUZZO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
7b.Side-Effects and Potential Complications
L.BADET,P.PETRUZZO,N.LEFRANÇOIS,E.MORELON,X.MARTIN,J.M.DUBERNARD . . . . . . . . . . . . . . . . . . . . . . 223
7c.CMV Infection and Reactivation
S.SCHNEEBERGER,R.MARGREITER,S.LUCCHINA, M.LANZETTA,H.BONATTI . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
7d.Specific T-Cell Response to HCMV Infection
G.LUCCHINI,P.PIOLTELLI,M.LANZETTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
7e.Ocular Complications after Hand Transplantation
D.VERITTI,P.LANZETTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
8.LIMB REJECTION AND MONITORING
8a.Skin Rejection in Human Hand Allografts:Histological Findings and Grading System
J.KANITAKIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
8b.Pharmacological Treatment ofRejection
P.PETRUZZO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
8c.Monitoring Rejection with a Distant Sentinel Skin Graft
M.LANZETTA,L.ROVATI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
9.FUNCTIONAL RECOVERY OF TRANSPLANTED HANDS
9a.Bone Healing in Hand Transplantation
M.GABL,S.PECHLANER,M.LUTZ,R.ARORA,M.BLAUTH,M.RIEGER,M.NINKOVIC,H.PIZA,
S.SCHNEEBERGER,R.MARGREITER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
9b.Return ofSensibility and Motor Recovery ofExtrinsic and Intrinsic Muscles
G.URSO,L.STROPPA,T.BARCHITTA,P.COSSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
XII Contents
9c. From Silent Neuroma to Reactivation ofAxonal Growth:How a Peripheral Nerve can Start
to Regenerate into a Transplanted Hand?
L.B.DAHLIN,G.LUNDBORG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
9d.Modified Visual Feedback in Rehabilitation
H.PARMENTIER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
9e. Analysis ofMotor Unit Reinnervation in Muscles ofthe Transplanted Hand
M.POZZO,D.FARINA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
9f.Role ofthe Sympathetic Nervous System on Arterial Distensibility
C.GIANNATTASIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
9g.An Instrumental Kit for a Comprehensive Assessment ofFunctional Recovery
V.MACELLARI,S.MORELLI,C.GIACOMOZZI,G.DEANGELIS,G.MACCIONI,M.PAOLIZZI,D.GIANSANTI . . . . . . . 327
9h.Human Brain Plasticity after Bilateral Hand Allograft
A.ABALLÉA,P.GIRAUX,M.SCHIEBER,J.M.DUBERNARD,A.SIRIGU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
9i.The Sensor Glove in Preoperative Conditioning and Postoperative Rehabilitation
G.LUNDBORG,B.ROSÉN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
9j.A Comprehensive Functional Score System in Hand Transplantation
M.LANZETTA,P.PETRUZZO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
9k.Quality ofLife in Hand Transplant Patients
D.BACHMANN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
10.PSYCHOLOGICAL ISSUES IN HAND TRANSPLANTATION
10a.Psychological Evaluation and Patient’s Profile
I.CARTA,O.CONVERTINO,J.BAGNASCO,S.FORNARA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
10b. Hand Transplant and Body Image
G.BURLOUX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
10c.Psychological Effects ofHand Transplantation
I.CARTA,O.CONVERTINO,J.BAGNASCO,S.FORNARA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
11.OTHER COMPOSITE TISSUE TRANSPLANT
11a.Allogeneic Vascularised Knee Transplantation
G.HOFMANN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
11b.Laryngeal Transplantation
R.R.LORENZ,M.STROME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
11c.Uterus Transplantation
W.FAGEEH,G.LUCCHINI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409