In late 2008, Chris Pollock lost his left hand and right forearm and
hand in a farming accident near his home in Harrisburg, Pa. This past February,
Pollock became only the second patient in the United States to receive a double
hand transplant. A team of doctors performed the 11-hour double hand transplant
and forearm replacement surgery at the University of Pittsburgh Medical Center.
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| W.P. Andrew Lee |
As of press time, five patients have received a total of eight hands in
the United States — three patients received double hand transplants and
two patients received a single hand transplant, according to W.P. Andrew Lee,
MD, chairman for the department of plastic and reconstructive surgery at Johns
Hopkins School of Medicine.
“Part of the patient selection criteria is for those patients who
not only know about the need for therapy but are motivated to carry out their
therapy,” Lee told O&P Business News.
According to Lee, patients begin active movement exercises with
occupational therapists 2 to 3 weeks post-surgery for 6 hours each day for at
least 6 months. Stretching exercises help reduce swelling in the operated area.
According to Lee, the extrinsic muscles, located in the forearm, are connected
to the tendons that eventually attach to the hand. When the patient makes a
fist, the muscles in the forearm pull the tendons to make that fist or to
straighten the fingers.
The physiologic process by which nerves regenerate is usually slow.
Generally, nerves regenerate at the rate of one inch per month or one
millimeter per day.
“The length of the nerves depends on the location of the
repair,” Lee explained. “It takes that period of time for the nerves
to regenerate all the way down to the fingertips. Nerves run throughout the
body including the upper extremity. If the transplant was performed at the
wrist level, then it is generally about 6 to 8 inches, so this may take 6 to 8
months. This is a rough estimation.”
Patients always regain extrinsic muscle function before the intrinsic
muscles, which are smaller, finer muscles within the hand, according to Lee. A
patient with improved intrinsic function may be able to pick up a coin from a
table top or button their own shirt.
As of press time, Pollock’s transplant is still the only
transhumeral transplant performed in the United States, according to Lee.
“Eight months after surgery, Pollock is doing well,” Lee said.
“He is still working in therapy with the same frequency and intensity as
when he started, and he is making steady progress. His left hand, transplanted
at nearly the wrist level, is beginning to have some sensation and intrinsic
muscle function.”
On his right side, according to Lee, Pollock has regained nearly normal
elbow flexion and extension and he is beginning to regain some of his extrinsic
forearm muscles. Due to this regained function, Pollock has begun to move his
right wrist and fingers. However, it will take some time before he performs
fine motor activities. If you take a ruler and measure the distance from the
elbow to your fingertips, it becomes clear that it will be a matter of years,
not months, before the nerves regenerate all the way down to Pollock’s
fingertips in his right hand.
“Patients may feel like the hands are extra weight with only
limited control early on in the process. They must be patient,” Lee said.
“A year or 2 is a long time for someone to do therapy, but when the nerve
regeneration process is complete, they will have a functional hand that
won’t be 100% normal, but will provide significant motor and sensory
function, which will improve functional tasks that one has to perform.”
— by Anthony Calabro
For more information:
- Calabro A. UPMC performs the nation’s second double hand
transplant. O&P Business News. 2010; 19(5):24. Available
online at oandpbusinessnews.com; search 63391.
Disclosure: W.P. Andrew Lee, MD, has
no direct financial interest in any companies mentioned in this article.
It has become increasingly evident over the past decade that the effects
of occupational therapy on upper extremity amputation and prosthetic
rehabilitation are positive and in fact, crucial. In some ways, the intensity
and longevity of therapy for hand transplant patients can be far greater than
for many amputee patients.
We have fully embraced the value of occupational therapists and their
treatments in rehabilitating our upper extremity prosthesis users. Regardless
of the longevity or intensity of therapy required for success, one of the
primary challenges is maintaining interest and motivation for the patient. Our
therapists work hard to select “real world” tasks for the patient.
The patient is inherently motivated to do things that interest them, and will
return them to activities that they enjoyed prior to the amputation. Careful
selection of these activities blended into some of the more routine therapeutic
modalities can help maintain a patient’s enthusiasm in their treatment
over long periods of time.
While the challenges for limb transplant patients can be much different
than for prosthetic rehabilitation, the importance of maintaining enthusiasm
and willingness to participate in therapeutic modalities is just as crucial.
— Dan Conyers, CPO
National clinical
director, Advanced Arm Dynamics Inc.
Disclosure: Dan Conyers, CPO, has no
direct financial interest in any companies mentioned in this article.
