Friday, October 28, 2011

Gaining ground in limb replacement surgery

SUCCESSFUL SURGERY: A team of MGH physicians,
led by Malt, far left, tend to Knowles’ right arm
following replantation surgery.

The first successful replantation of a human limb took place at the MGH in 1962. Now, nearly 50 years later, the Division of Plastic and Reconstructive Surgery is in the process of reviewing potential candidates for the latest in medical advances – hand transplantation surgery.

Everett “Red” Knowles was 12 years old when his arm was torn off at the shoulder after he was thrown against a stone abutment while hopping a freight train. His 11-member MGH team, led by chief surgical resident Ronald Malt, MD, and vascular surgeon Robert Shaw, MD, knew operations to join bones, blood vessels, skin, muscles and nerves had all been successful on an individual basis. But could they be combined? Their answer made replantation a reality.

Following the revolutionary surgery, Knowles not only had function and sensation in his arm, he returned to playing baseball, and later in life he was able to hold two full-time jobs, race cars and lift 20 pounds with his replanted arm. The blueprint for hand replantation surgeries had been drawn.

Today, MGH hand surgeons – who routinely perform hand replantation surgeries – hope to change the lives of countless amputees thanks to the evolving science of hand transplantation. Since the first successful hand transplant was performed in 1998 in Lyon, France, more than 70 upper extremity transplants have been performed worldwide. Clinical results indicate that upper extremity transplantation achieves satisfactory functionality as well as significant improvements in patient satisfaction and quality of life.

“While hand transplantation may be greatly life-enhancing, unlike solid organ transplantations – such as kidney or liver – these transplants are not necessarily life-saving procedures. The risks of treating the recipient with life-long immunosuppression to prevent rejection must be considered carefully,” says Curtis Cetrulo Jr., MD, of the Division of Plastic and Reconstructive Surgery. “The induction of transplant tolerance – in which the body’s immune system is fooled into accepting the hand transplant without immunosuppression – would greatly reduce the risk associated with these procedures, and in so doing, potentially make them more widely available to severely injured patients.”

The MGH Hand Transplantation Service is working with David H. Sachs, MD, director of the Transplantation Biology Research Center, to explore the new frontier in transplantation tolerance and make these procedures safer and more effective. Sachs was part of a team that developed a groundbreaking method for inducing tolerance, enabling the MGH to be the site of the first transplanted organ procedure that didn’t require immunosuppressive drugs in 2008. The MGH will use advanced immunomonitoring techniques to fine-tune and minimize the necessity for immunosuppression. In addition, it will be the first program to comply with the safety measures outlined by the United Organ Sharing Network and will employ new techniques to improve nerve regeneration in transplanted hands.

Read more articles from the 10/28/11 Hotline issue.


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