Medical creates history- first successful child’s hand surgery

Context:

• The first child in the world to undergo a double hand transplant is now able to write, feed and do major physical activities.

Introduction:

• The first official medical update on 10-year old Zion Harvey, who underwent surgery to replace both hands in July 2015, is more independent and able to complete day-to-day activities.
• At the age of 2, Zion Harvey lost his hands and feet to a life-threatening infection,
• 6 years later, at the age of 8 years old, Zion had both of his hands replaced in a double hand transplant.
• Now, he continues to improve as he undergoes daily therapy to increase his hand function, and psychosocial support to help deal with the ongoing demands of his surgery.
• Scans have shown his brain is adapting to the new hands, developing new pathways to control movement and feel sensations.
• Regular meetings with a psychologist and a social worker were part of the recovery process, aimed at helping him cope with his new hands

Complications in the process:

• Immunosuppressive drugs must be taken continuously to prevent a patient’s body from rejecting the transplant.
• But these drugs carry risks, including diabetes, cancer and infections.

Hand Transplant:

• Hand transplantationis a surgical procedure to transplant a hand from one human to another.
• The “donor” hand usually comes from a brain-dead donor and is transplanted to a recipient who has lost one or both hands/arms.
• Most hand transplants to date have been performed on below elbow amputees, although above elbow transplants are gaining popularity.
• Hand transplants were the first of a new category of transplants where multiple organs are transplanted as a single functional unit, now termed “Vascularized Composite Allotransplantation” or VCA.

The procedure:

• The operation is quite extensive and typically lasts from 8–12 hours.
• Surgeons usually connect the bones first, followed by tendons, arteries, nerves, veins, and skin.
• The recipient of a hand transplant needs to take immunosuppressive drugs similar to other transplants such as kidneys or livers, as the body’s natural immune system will try to reject, or destroy, the hand.
• These drugs cause the recipient to have a weaker immune system which may lead to an increased risk of infections and some cancers. There have been many advances in solid organ transplantation over the years that have made these medications quite tolerable.
• After the transplant, there is a period of extensive hand therapy/rehabilitation which helps the recipients regain function of the transplanted hand.
• Those patients who are dedicated to taking the medications and performing the physical therapy following a hand transplant have had remarkable success in regaining function of the new hands/arms.

Long run functionality:

• The long-term functionality varies patient to patient and is affected by several factors including level of amputation and transplant and participation in physical therapy post hand transplant surgery. For example:
• Hand transplant recipient Jonathan Koch was able to pick up a napkin and a tennis ball with his newly transplanted hand 7 days after his 17-hour surgery and by day 9, he was able to pick up a bottle of water and take a drink. 3 months after surgery, Koch was able to use his transplanted hand to tie his shoe.

Drawbacks in hand transplant:

• Awareness about the possibility of hand donation is very low.
• There is often resistance from the donor’s family to the idea of visibly damaging the body of a loved one.
• When matching the patient with a donor’s hand for a hand transplant, surgeons consider blood type, tissue type, skin color, comparable ages of donor and recipient, same sex between donor and recipient, hand size and muscle bulk. These criterions are quite hard to fall into place.
• The possible side effects of immunosuppressive drugs are well known and not to be ignored, with every patient experiencing at least one acute episode of rejection.
• Long-lasting immunosuppressant increases the risk of infection, neoplasia,