During the procedure
Hand transplant surgery is a complicated operation that can take 18 to 24 hours to perform. A team of surgeons will perform your surgery and should provide your family with periodic updates on how your surgery is progressing.
Once the donor hand is ready to be attached to your arm, your surgeons will first attach your bones to the bones of the donor hand using small metal plates. Your surgeons will then use special sutures (stitches) to attach the blood vessels, nerves and tendons. Surgeons use a special operating room microscope to place the sutures. Once all the parts of the donor hand and recipient's arm have been attached, the skin is closed.
After the procedure
After your surgery, you'll be placed in an intensive care unit (ICU). Your health care team will check for function in your donor hand or hands, and you'll be asked to try to move your fingers. It's possible the room that you stay in will be kept at a higher temperature to promote blood circulation in your donor hand or hands. Once you're stable enough to leave the ICU, you'll move to a different hospital room. You can expect to stay in the hospital for seven to 10 days following your transplant.
Your health care team will help you manage your pain following your transplant. It's important to communicate to your team how serious your pain is, since managing your pain can speed up your recovery.
A special hand therapist also will work on physical therapy with you while you're in the hospital. He or she will teach you exercises to get your hand functioning. In between exercise sessions, you'll wear a splint on your hand to keep it stable. You'll also be taught exercises to perform on your own.
It's normal to have some emotional concerns soon after your surgery. You may have trouble sleeping and adjusting to your new routine of caring for your donor hand or hands. Talk to members of your transplant team if you have any emotional concerns.
Immunosuppressant medications can help stop your immune system from destroying your donor hand or hands. Following your procedure, you'll begin to take immunosuppressant medications and will continue to do so for the rest of your life. To decrease the risk of side effects from immunosuppressant medications and the risk of rejection, you should:
- Take your immunosuppressants at the same time and in the same way every day (with or without food).
- Never stop taking the medications unless directed to do so by a doctor.
- Expect side effects from the medications, and work with your transplant team to minimize the side effects.
- Have regular blood tests to check the effectiveness of your immunosuppressants.
While immunosuppressants can help reduce your risk of rejection, they can also lower your body's ability to fight off infections. If you have any signs that you're becoming ill with an infection, such as fever, rash or swelling, contact your transplant team or your doctor.
June 24, 2011
- Barbara Woodward Lips Patient Education Center. Hand and arm transplantation. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2010.
- Information for potential hand transplant patients. Composite Tissue Allotransplantation. http://www.handtransplant.com/TheProcedure/InfoforPotentialPatients/tabid/103/Default.aspx. Accessed Jan. 12, 2011.
- Petruzzo P, et al. The International Registry on Hand and Composite Tissue Transplantation. Transplantation. 2010;90:1590.
- Lanzetta M, et al. Second report (1998-2006) of the International Registry of Hand and Composite Tissue Transplantation. Transplant Immunology. 2007;18:1.
- Kaufman CL, et al. A new option for amputees: Transplantation of the hand. Journal of Rehabilitaion Research and Development. 2009;46:395.
- Cendales L, et al. Implementation of vascularized composite allografts in the United States: Recommendations from the ASTS VCA Ad Hoc Committee and the Executive Committee. American Journal of Transplantation. 2011;11:13.