A team of surgeons gave 32-year-old Dave Robert Armstrong of Upland a hand, last July -- literally.
Just 10 years earlier, that wouldn't have been possible. But in September 1998, the first hand transplant was performed in Lyon, France, and since then more than 30 people around the world have received such a transplant -- sometimes, two.
Other patients have received arms, faces and abdominal walls -- varied types of composite tissue allotransplantation, or CTA, meaning multiple tissues are involved (skin, muscle, tendon, bone, cartilage, fat, nerves, blood vessels) and the body part comes from a brain-dead donor.
These CTA procedures are being done with "a very, very high success rate," says Dr. L. Scott Levin, professor of orthopedic and plastic surgery and chief of plastic surgery at Duke Medical Center in Durham, N.C. (So far only hand and abdominal wall transplants have been done in the United States.)
Additional types are considered possible. "We're on the frontier of this field," says Dr. Gordon Lee, a plastic surgeon and director of microsurgery at Stanford Hospital.
And some of the field's pioneers believe it has vast potential. "We feel we can help many more people than we're helping now," says Dr. Stefan Schneeberger, director of the University of Pittsburgh CTA Program.
To date, though, CTA is expensive, risky and possibly shortens the lives of those who undergo it.
Gauging success
A successful hand transplant is one in which the hand survives and is functional, says Dr. Warren Breidenbach III, who led the team in Louisville that performed Armstrong's transplant in July.
Breidenbach and his team from the Kleinert Kutz Hand Care Center, in partnership with Jewish Hospital and the University of Louisville School of Medicine, have performed all four hand transplants that have been done in the U.S., including the world's first successful one in 1999.
(The 1998 hand transplant in France was considered successful until the recipient asked to have it removed, saying he felt "mentally detached" from it.)
Function doesn't happen overnight. The surgeons join at least three nerves in the transplanted hand -- two large and one smaller branch -- to ones in the recipient's arm, and the nerves in the transplant die. Then the recipient's nerves grow down into the transplant, and function grows with them.
In full arm transplants, the nerves have farther to grow, so function is slower to develop, and there's a greater chance that it might not.
