Hand transplantation

Since the first hand transplantation was performed more than a decade ago, much has been learned about the risks and benefits of this procedure. It is now clear that the procedure is technically possible and the transplanted hand will survive with appropriate immunosuppression. While controversy remains, there is increasing acceptance of the procedure in appropriately selected patients. Technically, the procedure is similar to replantation of an amputated hand with some important distinctions: no zone of injury, more skin for coverage, and important challenges with recipient and donor muscle tensioning. Acute rejection is common but manageable with steroids and modification of immunosuppressive therapy. Quantifying function is challenging, as no perfect measure exists. However, outcome measures assessed are quite favorable but require an intense hand therapy program. There are unique psychosocial considerations in this patient population, and careful patient selection is critical to a successful outcome.