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Just months after performing the nation’s second face transplant, BWH took another step forward in pioneering transplant surgery. Earlier this year, the hospital gained approval to perform hand transplants.
“A hand is more than something you grab a cup with,” said Bohdan Pomahac, MD, director of the BWH Burn Center and principal investigator of the face and hand transplantation programs. “The hand touches loved ones; you use it to perform personal hygiene, eat and shake someone else’s hand. And for the blind, hands are their eyes.”
Worldwide, about 40 patients have undergone hand transplantation, with the first surgery performed nearly a decade ago. Potential candidates have suffered trauma and burns, and some veterans of the war in Iraq and Afghanistan are returning with extremity injuries that may require hand amputation.
“It’s a restorative operation unlike any that has previously existed,” said Matt Carty, MD, of Plastic Surgery, the surgical lead for the hand transplantation program. “Transplant is a leap above prostheses in that we are giving something that functions like a hand and also feels sensation.”
The surgery is complex, often lasting between 12 and 15 hours. “You connect the bones, then the blood vessels, then the tendons and nerves and finally the skin,” said Carty.
Recipients may not gain full wrist motion, but the transplant enables finger motion and sensation. In comparison, Pomahac said that many people who receive sophisticated hand prostheses find them difficult to operate and, in the end, return to a hook.
Post-surgery, recipients must undergo extensive rehabilitation, and Plastic Surgery is working closely with Rehabilitation Services on the protocol. “It requires an ongoing commitment from the patient because function keeps improving for up to four years after,” said Carty.
Marie-Jose Benjamin, MS, OTRL, CHT, and her colleagues from Rehabilitation Services, are working to establish a comprehensive rehabilitation protocol for hand transplant patients. “It’s a long process, and patients need to be educated about it beforehand” said Benjamin, a certified hand therapist who has been researching the rehabilitation protocols of other centers that perform this operation.
Carty added, “We’re very excited to recruit appropriate candidates and to build on the experience of institutions that have performed this type of transplant. It is a great gift for our patients.”
Learn more online at www.brighamandwomens.org/handtransplant