REVIEW OF FIRST LOUISVILLE BILATERAL HAND TRANSPLANT REHABILITATION COURSE

Laurie Newsome¹, Anne Hodges¹, Ashley Buren Emrich¹, Selena McGill¹, Christina Kaufman¹, Brenda Blair¹.

¹Christine M. Kleinert Institute, Louisville, KY, USA.

Purpose: Our center recently performed a bilateral hand transplant on a burn patient at the level of the wrist on both hands. We report here the novel challenges of therapy encountered in this case, with respect to the type of transplant as well as the complications and circumstances individual to this patient.

Methods: Initial parameters of treatment were based on our experience with our 5 unilateral patients, and the unique surgical reconstruction in this case. Complications that affected his therapy progress were identified. His usual schedule was 4 hours of therapy 5 days a week, similar to our unilateral patients. Outcomes were measured by range of motion, grip and pinch strengths, sensory return (using tinel’s sign) and Carroll test.

Results:This patient showed excellent early digit motion, with ability on the left to approximate tips to palm on all fingers except small on post op day 2. On the right, he was able to make ¾ full fist with 2-5 fingers. Starting at post op day 14, vascular compromise on the right and resulting surgeries as well as rejection delayed therapy on the right for 8 days. For 7 additional days, on the right, only finger ROM was permitted. On the left, poor wrist extension strength hindered functional gains. Complications resulted in extension of his stay from 90 to 126 days. In spite of complications, our bilateral patient began using his hands for everyday functional tasks 9 ½ weeks post surgery, and gradually added more activities such as shaving, drinking from a cup and water bottle 2 handed, and feeding himself.

Conclusions:Despite multiple complications, this patient has attained good function with his new hands. His outcome measurements at 3 months post surgery, with a few exceptions, were generally similar or superior to our previous unilateral patients.