About the Procedure

Preparation

Once an appropriate donor is found for the patient, the patient will immediately be called to the hospital and admitted for transplantation. Final preparatory tests such as an EKG, chest X-ray, and blood analysis will be performed, and pre-operative medications, including the first dose of antirejection medication, will be initiated.

Procedure

During the transplant surgery, general anesthesia is administered to put the patient to sleep. Prior to the procedure, the patient will receive a regional block to help control pain after the surgery. Intravenous lines will be placed in either the neck or groin region by an anesthesia provider prior to surgery.

Hand transplantation involves the placement of the donor hands onto the recipient’s amputation stumps. There are two to four surgical teams composed of reconstructive hand and microsurgeons who prepare the donor and recipient hands. Once this is accomplished, the following structures are reconstructed in order to restore the hands:

  • Forearm bones (radius and ulna)
  • Tendons (that flex and extend the wrist, fingers, and thumb)
  • Blood vessels (arteries and veins)
  • Nerves
  • Skin

On average, the transplant surgery lasts from 10 to 18 hours. This is a lengthy procedure, and the patient receives blood products and fluids throughout the surgery. Drains may be placed to help collect extra fluid and help with healing. A probe will be placed around the artery or vein to ensure blood flow is adequate throughout the vessels of the newly transplanted hand.

Recovery

After the procedure, the patient goes to the intensive care unit for up to 5 days. Occupational therapy and physical therapy specialists evaluate the patient, and hand therapy sessions begin within two to three days after surgery. The patient is then transferred to the transplant floor, where he or she stays for about two weeks. The total length of stay is about 21 days.

Procedures that may occur in the intensive care unit and transplant floor include, but are not limited to, skin biopsies, bedside vascular ultrasounds, and daily hand splint and dressing changes. 

The patient is expected to follow-up with both the transplant clinic and occupational therapists after leaving the hospital. The transplant patient takes medications to suppress the immune system in order to prevent rejection. The transplant team monitors the patient for any complications or signs of rejection. Over time, the team will attempt to decrease the dosage and number of medications to minimize the potential for drug-related side effects.

After the transplant, the patient must learn how to use the new hand(s). It is critical for the patient to actively participate in hand therapy at least five days a week. This is to optimize the function of the newly transplanted hand(s).

The transplant patient is followed closely by the hand transplant team in order to ensure that the graft is functioning well, any rejection is treated, and the overall needs are being met. The primary goal of the team is the patient’s safety and restoration.

For more information, please view the Hand Transplant Journey.

Hand Therapy

After transplant, the patient is expected to undergo intensive hand therapy. This consists of daily supervised exercises and homework on weekends. As the patient regains more function and becomes more independent, the therapy sessions will be less frequent and the simple acts of daily living will constitute the bulk of rehabilitation.

For more information on what to expect with hand therapy, please view Therapy Following Hand Transplantation.