PLASTIC SURGERY
Fig. 1. Attachment of the 1999 Louisville hand transplant.
(continued from page 21)
based in France performed a hand transplant with no minimal
psychological screening on a recipient from New Zealand who
had lost his hand in prison. Although the procedure was techni-
cally successful, the patient was non-compliant to rehabilitation
therapy and medication monitoring. His transplanted hand never
gained function, and it underwent progressive rejection, leading to
amputation after several months.
THE LOUISVILLE HAND TRANSPLANT
After Institutional Review Board approval, and a careful patient
selection process, Dr. Warren Breidenbach led the team in per-
forming the landmark Louisville hand transplant in January 1999.
It was a technical success, and was followed by careful monitoring,
intensive hand therapy and progressive return of useful function
(Fig. 2). The recipient was able to return to his former occupation
as an emergency medical technician and instructor, where he uses
his transplanted hand in intubations, starting IVs and manual
intensive care activities. At 20 years, his transplant remains stable
and highly-functional. In demonstrating excellent function and
expressing his high degree of satisfaction, he has been an inspiration
to programs around the world entering limb transplantations, and
to their recipients (Fig. 3).
CONSEQUENCES OF THE EVENT
As the success of the Louisville hand transplant became apparent,
programs have been successfully established around the world
22
LOUISVILLE MEDICINE
Fig. 2. Early regaining of function
being checked by Dr. Breidenbach and
Dr. Tobin.
to replicate this breakthrough and to extend the frontiers. A new
surgical field designated as Vascular Composite Allotransplantation
(VCA) has arisen, with formal societies, regular meetings, dedicat-
ed journals and regular reports in the established plastic surgery
journals. About 300 of such transplants have now been done. These
fall into the major categories described below.
UPPER EXTREMITY TRANSPLANTS
Approximately 120 upper extremity transplants have now been
reported. A substantial number of these are bilateral, where func-
tional needs are more severe. With success established at wrist and
distal forearm, transplants of more proximal amputations have been
transplanted, including at high trans-humeral levels.
FACE TRANSPLANTS
With the principle of skin-bearing transplants established in the
hand, severe facial deformities became the next application. The
first facial transplant was done in France in 2005 for total loss of
lips, plus central cheeks and nose. Subsequently, several total facial
transplants have been done. To date, there have been about 40 face
transplants, and the recovery of speech, oral continence and facial
expression has been excellent. These surgeries have been extended
beyond soft tissues to include the underlying maxilla, mandible
and oral cavity.
ABDOMINAL WALL TRANSPLANTS
Transplants of the abdominal wall are done for children undergoing