Mayo Clinic is on the leading edge of a new era in transplantation aimed at improving the quality of life for people who have sustained debilitating injuries. Mayo's new Hand Transplant Program in Rochester, Minn., can make a dramatic difference in the day-to-day lives of people with severe hand injuries or amputation of both hands.
Until recently, people with severed or severely damaged limbs received a prosthesis or had tissue moved from another area of the body to the hand to restore function. A hand transplant can restore both function and sensation. And it gives patients the opportunity to return to a state of wholeness.
There is a growing population of U.S. military veterans with missing limbs, many of whom lost limbs in the wars in Iraq and Afghanistan. While body armor saves lives, it does not protect the extremities, and many servicemen and -women have sustained severe extremity injuries. According to Steven L. Moran, M.D., Mayo Clinic plastic surgeon and co-director of the Mayo Clinic Hand Transplant Program, many other patients would also benefit from hand transplantation.
Candidates for hand transplantation at Mayo Clinic include people ages 25 to 65 years, with severe or mutilating injuries to both hands or, in special cases, to a single hand. Although the Mayo Clinic program has yet to conduct its first transplant, several patients are currently going through the extensive screening process. After screening is completed, the wait begins for the right donor. Mayo Clinic hopes to complete its first hand transplant sometime in 2011.
The hand transplantation procedure and rehabilitation process are highly complex, and it has only recently become possible. According to Dr. Moran, hand transplantation is a natural extension of what Mayo Clinic already does well, including heart, lung, liver, kidney and pancreas transplantation, and surgeries to reimplant or reattach severed arms and hands.
"We have extensive experience and national recognition with transplantation and hand surgery," explains Dr. Moran. "This experience, coupled with one of the strongest rehabilitation programs in the country, is one of the many reasons Mayo has embarked on this endeavor to help people who have had traumatic loss of their hands. This program will allow us to stay on the forefront of regenerative and transplant medicine," Dr. Moran adds.
Following surgery, the care team will carefully monitor blood flow, infection, rejection, muscle strength and nerve regeneration. And like all transplant recipients, patients who receive a hand transplant must take immunosuppressants every day for the rest of their lives to prevent their bodies from rejecting their new hands.
Intensive rehabilitation and regular follow-up clinic visits are necessary to ensure long-term success of the transplant. Physiatrists and physical and occupational therapists are critical members of the rehabilitation team.
While the procedure promises the return of sensation in the hands and fingers, daily physical or occupational therapy is required, and feeling in the fingers may not occur for up to a year. Patients must be highly motivated to do the exercises because there is a risk that motion and function in the transplant will fail.
"Mayo Clinic rehabilitation specialists play a key role in restoring function after these complex surgeries," says Mayo Clinic physiatrist Mary L. Jurisson, M.D. "Our rehabilitation team provides comprehensive rehabilitation services for patients who are treated with traditional approaches, such as the use of prosthetics. Hand transplantation offers another option when a prosthesis is not adequate to the patient's needs, and our rehabilitation team is prepared to help these patients regain function and learn to use their new hands."
Several dozen successful hand transplants have been performed over the past decade, but Mayo Clinic's program is the first clinically approved hand transplant program in the United States. The transplant and rehabilitation team traveled to Paris earlier this year to learn more from the innovators of hand and face transplantation.