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Health worker first in U.S. to undergo hand transplant
Tuesday, January 26, 1999 By Anita Srikameswaran, Post-Gazette Staff Writer
A New Jersey health care worker has become the first person in the United States - and the second in the world - to receive a hand transplant, 13 years after his own was lost in a firecracker explosion.
Matthew David Scott, 37, of Absecon, was recovering at Kentucky's Louisville Jewish Hospital after the 15-hour operation, which ended in the early yesterday morning.
Scott, clinical coordinator for Virtua Health System in Gibbsboro, N.J., and assistant director for the School of Paramedic Science at Camden College in Blackwood, N.J., lost his dominant left hand Dec. 23, 1985, in a blast from an M-80 firecracker. He had been using a prosthetic device until the surgery.
"The critical period is the first few days," said Dr. Warren Breidenbach, leader of the transplant team. Scott faces an 80 percent or greater chance of a blood clot in the first 24 hours, but the risk should drop to as little as 5 percent by the third day.
Scott will probably have to take anti-rejection drugs for the rest of his life so his body does not attack the foreign hand tissue, which came from a cadaver.
Some physicians say the long-term use of immune suppression medications poses risks of deadly infections and cancer that are too high a price to pay for a non-essential transplant.
"Somebody's going to die without a [donor] heart, lung or kidney, so one can justify [the drugs]," said Dr. Matthew Tomaino, chief of microsurgery in the orthopedic department at UPMC Health System.
He cautioned that a transplanted hand won't work well immediately after surgery, unlike organs, and that improvement in function may not be as dramatic as patients hope to see. While the wrist and fingers should be able to bend and straighten, he said, the grip will be weak and the fingers may not spread out - in other words, fine control won't return to normal.
"It'd really be for very gross tasks," and a prosthetic can accomplish many of those functions without a need for medications, Tomaino said.
The surgery is not technically difficult. The bones, tendons, nerves and blood vessels from the patient's stump are attached to the donor hand, much the same as a hand might be reattached, or replanted, into the same patient, he added.
Dr. Ramon Llull of UPMC said that in some ways the new procedure could have better results than reattachments of severed hands. If a hand is crushed, for example, it can be difficult to find undamaged tissue to use for reconstruction. With a donor limb, the surgeon can choose where the attachment should be located and amputate it cleanly.
Llull, who will finish his training in plastic surgery this summer, has eagerly followed the progress of hand transplants. He hopes to start a hand transplant program, which is now only available in Louisville, wherever he eventually chooses to practice.
According to Llull, plastic surgeons are beginning to explore transplants as a source of tissue for reconstruction. After a liver transplant, a gap in the abdominal wall could be fixed with donor muscle. In Germany, a few patients have received human donor knee joints to replace those that could not be fixed with prosthetics.
"I had the opportunity to examine these [German] patients," he said. "I was pleased to confirm that these patients are doing beautifully despite the fact that they're on immunosuppression drugs. A transplant saved them from certain amputation."
Many people have used anti-rejection drugs for years with few problems, added Llull, who also has a doctorate in immunology.
He agreed with Tomaino that a transplanted hand would not be as good as new.
"We are not looking for a hand that will function perfectly," Llull said, "but we're trying to provide as much function as possible."
That means a hand that could be used for dressing, combing hair, eating and pushing the buttons on a phone. But it may never sense like the original hand.
Bones, muscle, tendons and blood vessels can be reattached with plates, screws and simple stitches and will heal well.
Nerves are another matter. They can be sewn together, but they may be permanently impaired. The muscles that flex and extend the fingers and wrist begin near the elbow and fill out the forearm, and they get their nerve supply just below the elbow. Their motions can be saved by a reattachment or transplant.
The muscles that originate in the hand have their own nerve supply, though, Tomaino said, but those transplanted nerves are unlikely to regain full function. That could leave the transplanted hand a little numb and weak compared to normal.
"Particularly when you get people over 20 years old, the potential for sensation coming back anything close to normal is really limited," he said. "The bottom line is that it's possible to attach a hand and have it be alive, but whether it's going to be of any use, rather than this numb appendage, is the question."
Denise Kynor, 53, of McKeesport, is glad for the pins-and-needles sensation in her left arm.
In March 1997, her arm got caught in a workplace garbage disposal machine. She was freed after four hours and flown to the hospital. All that was keeping the limb attached to her body was a piece of skin on the back of her arm, four inches below the shoulder.
When she awoke from the first of what would become seven surgeries, Kynor was thrilled to find that surgeons had reattached the limb. Complications with infection, however, caused her to lose her thumb, one finger and some muscle from the back of her forearm.
"I'm glad I still have my arm," she said. "It's not perfect. I can't lift heavy objects. To turn on a light switch or open a screen door, I can't do those things."
Six months after the reattachment, Kynor got some feeling back in the limb. A prosthesis would have left her with no sensation at all, she pointed out.
"First thing you start to feel is cold and hot," she said. A few months later, her arm would feel like it had fallen asleep. "It does get annoying. I've told myself I'd have to live with it. I'd rather have this than a prosthesis."
Kynor said she became excited about the possibility of a hand transplant after the first such operation took place in France last year, but when she asked her doctor about it, he advised against it until more is known about the procedure.
That initial transplant was performed in Lyons, France, Sept. 23 by an international medical team. The patient was 48-year-old Clint Hallam, a New Zealand man who had lost part of his right arm in a 1984 prison workshop accident while serving a sentence for fraud in his home country. Hallam is reported to be doing well, Llull said, but few details are available about the functioning of his transplanted hand.
After several years of research, doctors at the Louisville hospital announced their intention of performing hand transplant surgery in July 1998 but did not schedule the surgery until this month.
For more information on this procedure, check the Louisville surgical team's Web site at: http://www.handtransplant.com.
The Associated Press contributed to this report.
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