Purpose
Currently, numerous assessment tools are available to measure functional outcomes
after bilateral hand transplantation. The purpose of this article is to present our
experience utilizing quantitative assessment tools for functional evaluation and to
describe our results after bilateral hand transplantation.
Methods
A single surgeon’s experience with bilateral hand transplantation from 2011 to 2016
was retrospectively reviewed. Three bilateral hand transplantations were performed
in 2 adults and 1 child. A minimum 2-year follow-up evaluation was available. For
the adult patients, postoperative outcome measures included patient-reported pain
and disability scores, return of sensation, muscle strength, range of motion, and
return to work/activities of daily living, the Hand Transplant Scoring System (HTSS),
the Sollerman hand function test, and complications. For our pediatric patient, postoperative
outcome measures included the Functional Independence Measure for children (WeeFIM)
scale, a functional independence measure for children, the 9-Hole Peg Test, the Box
and Block test, and complications.
Results
Our 2 adult patients were age 28 and our pediatric patient was age 8 at transplantation.
Follow-up ranged from 2 to 7 years. The functional assessments were performed over
a period from 11 to 48 months after transplantation. Both adult patients achieved
functional independence and the HTSS, Short Form-36 Health Score (SF-36), DASH, and
Sollerman tests demonstrated sequential improvement compared with pretransplantation
scores assessed with the use of prostheses. Our pediatric patient demonstrated improvement
in his Box and Block test score for each hand at sequential visits after transplantation.
His 9-Hole Peg Test demonstrated improvement, and his WeeFIM assessment at 20 months
indicated a greater level of independence.
Conclusions
Patient-reported outcomes and the Sollerman test when used in addition to the HTSS
appear to reflect functional improvement in adult patients after bilateral hand transplantation.
Although children pose a unique challenge with functional assessment, we found the
WeeFIM assessment, 9-Hole Peg Test, and the Box and Block test helpful in evaluating
functional outcomes in our pediatric patient.
Type of study/level of evidence
Therapeutic V.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The International Registry on Hand and Composite Tissue allotransplantation.Clin Transpl. 2011; : 247-253
- Cortical reorganization in motor cortex after graft of both hands.Nat Neurosci. 2001; 4: 691-692
- Massive cortical reorganization is reversible following bilateral transplants of the hands: evidence from the first successful bilateral pediatric hand transplant patient.Ann Clin Transl Neurol. 2018; 5: 92-97
- Rehabilitation following hand transplantation.Hand (N Y). 2014; 9: 9-15
- Bilateral hand transplantation: functional benefits assessment in five patients with a mean follow-up of 7.6 years (range 4–13 years).J Plast Reconstr Aesthet Surg. 2015; 68: 1171-1183
- Hand transplantation: rehabilitation: case report.Microsurgery. 2000; 20: 389-392
- Rehabilitation after bilateral hand transplantation in the quadrimembral patient: review and recommendations.Tech Hand Up Extrem Surg. 2013; 17: 215-220
- Hand transplant—outcome after 6 months, preliminary report.Ortop Traumatol Rehabil. 2010; 12: 90-99
- First Polish forearm transplantation—final report (outcome after 4 years).Ann Transplant. 2010; 15: 61-67
- Successful hand transplantation. One-year follow-up. Louisville Hand Transplant Team.. N Engl J Med. 2000; 343: 468-473
- World experience after more than a decade of clinical hand transplantation: update from the Louisville Hand Transplant Program.Hand Clin. 2011; 27: 417-421
- Functional outcome after hand and forearm transplantation: what can be achieved?.Hand Clin. 2011; 27: 455-465
- Hand transplantation in the United States: experience with 3 patients.Surgery. 2008; 144 (discussion 43–44): 638-643
- Outcomes of the first 2 American hand transplants at 8 and 6 years posttransplant.J Hand Surg Am. 2008; 33: 1039-1047
- Outcomes after bilateral hand allotransplantation: a risk/benefit ratio analysis.Ann Surg. 2015; 261: 213-220
- Norm scores of the box and block test for children ages 3–10 years.Am J Occup Ther. 2013; 67: 312-318
- (GOAL) Goal-Oriented Assessment of Lifeskills.WPS, Torrance, CA2013
- Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG).Am J Ind Med. 1996; 29: 602-608
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Med Care. 1992; 30: 473-483
- A comprehensive functional score system in hand transplantation.in: Lanzetta M. Dubernard J.-M. Petruzzo P. Hand Transplantation. Springer, Milano, Milan, Italy2007: 355-362
- Evaluation of ADL-function—especially hand function.Scand J Rehabil Med Suppl. 1978; 6: 139-143
- Dexterity as measured with the 9-Hole Peg Test (9-HPT) across the age span.J Hand Ther. 2015; 28 (quiz 60): 53-59
- The Functional Independence Measure for Children (WeeFIM). Conceptual basis and pilot use in children with developmental disabilities.Clin Pediatr (Phila). 1994; 33: 421-430
- The International Registry on Hand and Composite Tissue Transplantation.Transplantation. 2005; 79: 1210-1214
- Hand transplantation: ethics, immunosuppression and indications.J Hand Surg Br. 2001; 26: 511-516
- The ethics of hand transplantation: a systematic review.J Hand Surg Am. 2018; 43: 84.e1-84.e15
- A quantitative test of upper extremity function.J Chronic Dis. 1965; 18: 479-491
Article info
Publication history
Published online: July 16, 2020
Accepted:
May 6,
2020
Received:
May 14,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
