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Successful bilateral hand transplantation may usher new dimension of limb salvage
Results of first bilateral hand transplantation exceeds expectations at Children's Hospital of Philadelphia.
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In August, the Children’s Hospital of Philadelphia, Penn Medicine and Shriner’s Hospitals for Children celebrated the 1-year anniversary of their collaboration on the first bilateral hand transplant on a pediatric patient.
Surgical planning
When Zion Harvey was 2 years old, he developed an infection that required the amputation of his hands and feet, as well as a kidney transplant to save his life. He was referred to the Hand Transplantation Program at the Children’s Hospital of Philadelphia by Shriner’s Hospital, where L. Scott Levin, MD, FACS, chairman of the Department of Orthopaedic Surgery and professor of surgery of the Division of Plastic Surgery in the Perelman School of Medicine at the University of Pennsylvania, put together a surgical team that performed Harvey’s surgery, a procedure that took 2 years to plan.
“The surgery itself was commensurate with an arm replantation in a child, which we have done over years, but an extensive amount of planning was done in terms of the osteotomies that we were performing,” Levin said.
According to Levin, the team performed several surgical rehearsals during the months prior to the actual surgery to make sure the steps involved in Harvey’s surgery would be efficient. Now, 1 year after his surgery, Harvey has exceeded the expectations of Levin and his colleagues in his rehabilitation progress.
“He can eat, write, clothe himself, [use the] toilet and is independent for the first time in 7 years of his life,” Levin said. “[He] still requires the use of lower extremity prosthetics because he has no legs, but can put these on himself at this point and is doing well from a functional and emotional standpoint.”
Barriers for restorative surgery
According to Levin, Harvey’s surgery has ushered in “a new dimension in limb salvage and reconstruction” called restorative surgery.
“We have moved from substituting tissues to reconstructing tissues, such as the use of conventional microsurgery techniques, flaps [or] vascular bone grafts, and now we can take an entire limb and restore function, restore aesthetics, restore body image, restore social integration by transplantation,” he said.
Although Levin believes the field of restorative surgery will continue to evolve and improve for patients, there are still a number of barriers that prevent it from becoming a routine surgery for children.
“The barriers of doing [restorative surgery] on a routine basis in children relate to the immunology and the requirement for immunosuppression, which is a medical and ethical consideration, and currently, these surgeries are not covered by insurance or government payers; that is another hurdle that this new field will need to deal with,” Levin said. “But, it is following the legacy and history of solid organ transplant, where many of the solid organ transplants initially were not paid for and then ultimately they were.” – by Casey Tingle
- For more information:
- L. Scott Levin, MD, can be reached at Penn Medicine University City, 7th Fl., 3737 Market St., Philadelphia, PA 19104; email: abbey.anderson@uphs.upenn.edu.
Disclosure: Levin is funded by the Department of Defense and by The Wyss Foundation.