Limb Transplantation in Congenital Deformities

  • Aram Gazarian
  • Davit O. Abrahamyan


This chapter presents current issues for possible limb transplantation in newborns and indicates directions, which will be likely to produce some answers on different feasibility aspects. Even if total hand transplantation (HT) will never be used in congenital individuals, current research advancements may allow composite tissue allotransplantation (CTA) to be an adequate tool for managing many currently “incurable” malformations presenting with different missing anatomical parts. There are numerous cases of congenital limb deformities (CLD) in which failure of formation or development has no surgical answer because we are unable to restore or properly replace the missing parts. “Confusion arises also from the circumstance that these anomalies are never exactly alike” [1].


Residual Limb Congenital Deformity Radioulnar Synostosis Limb Deficiency Hand Transplantation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kelikian H (1974) Congenital deformities of the hand and forearm. WB Saunders, PhiladelphiaGoogle Scholar
  2. 2.
    Lundborg G (2000) Tomorrow’s artificial hand. Scand J Plast Reconstr Surg Hand Surg 34:97–100PubMedCrossRefGoogle Scholar
  3. 3.
    Lorenz HP, Hedrick MH, Chang J et al (2000) The impact of biomolecular medicine and tissue engineering on plastic surgery in the 21st century. Plast Reconstr Surg 105:2467–2481PubMedCrossRefGoogle Scholar
  4. 4.
    Eppley BL (2001) Paediatric plastic surgery revisited. Clin Plast Surg 28:731–444PubMedGoogle Scholar
  5. 5.
    Breuer C, Anthony T, Fong P (2004) Potential tissueengineering applications for neonatal surgery. Semin Perinatol 28:164–173PubMedCrossRefGoogle Scholar
  6. 6.
    Chong AK, Chang J (2006) Tissue engineering for the hand surgeon: a clinical perspective. J Hand Surg [Am] 31:349–358CrossRefGoogle Scholar
  7. 7.
    Dubernard JM, Owen E, Herzberg G et al (1999) Première transplantation de main chez l’homme. Résultats précoces. Chir 124:358–365CrossRefGoogle Scholar
  8. 8.
    Dubernard JM, Owen E, Herzberg G et al (1999) Human hand allograft: report on first 6 months. Lancet 353:1315–1320PubMedCrossRefGoogle Scholar
  9. 9.
    Petit F, Paraskevas A, Garrido I, Lantieri L (2005) La transplantation est-elle l’avenir de la microchirurgie? Ann Chir Plast Esth 50:76–79CrossRefGoogle Scholar
  10. 10.
    Hettiaratchy S, Randolph MA, Petit F et al (2004) Composite tissue allotransplantation — a new era in plastic surgery? Br J Plast Surg 57:381–391PubMedCrossRefGoogle Scholar
  11. 11.
    Petit F (2002) Allotransplantation de tissus composites et chirurgie réparatrice. Les premières applications cliniques. Maîtrise Orthopédique 111. www.maitrise-orthop.comGoogle Scholar
  12. 12.
    Swanson AB (1976) A classification for congenital limb malformations. J Hand Surg [Am] 1:8–22Google Scholar
  13. 13.
    James MA, Bednar M (2005) Deformities of the wrist and forearm: transverse failure of formation. In: Green DP et al (eds) Green’s operative hand surgery, 5th Edn, Vol 2. Elsevier Churchill Livingstone, Philadelphia, pp 1489–1491Google Scholar
  14. 14. Scholar
  15. 15.
    Foucher G (1999) Commentary: prospects for hand transplantation. Lancet 353:1286–1287PubMedCrossRefGoogle Scholar
  16. 16.
    Lundborg G (1999) Hand transplantation. Scand J Plast Reconstr Surg 33:369–371CrossRefGoogle Scholar
  17. 17.
    Manske PR (2001) Hand transplantation. J Hand Surg [Am] 26:193–195CrossRefGoogle Scholar
  18. 18.
    Jones NF (2002) Concerns about human hand transplantation in the 21st century. J Hand Surg [Am] 27:771–787CrossRefGoogle Scholar
  19. 19.
    Lees VC, McCabe SJ (2002) The rationale for hand transplantation. Transplantation 74:749–753PubMedCrossRefGoogle Scholar
  20. 20.
    Gazarian A, Gonnaud F, Queney-Rouyer AP (2000) Trois regards, une consultation. Prise en charge interdisciplinaire des anomalies congénitales de la main. Le Pédia 200:6–11Google Scholar
  21. 21.
    Mertes K (2006) Personal communicationGoogle Scholar
  22. 22.
    Peillon B (2006) Personal communicationGoogle Scholar
  23. 23.
    McCarroll HR (2000) Congenital anomalies: a 25-year overview. J Hand Surg [Am] 25:1007–1037Google Scholar
  24. 24.
    McGuirk CK, Westgate M-N, Holmes LB (2001) Limb deficiencies in newborn infants. Pediatrics 108:E64PubMedCrossRefGoogle Scholar
  25. 25.
    Apkon S (2004) Pediatric limb deficiencies. PM&R Update 8:1–4Google Scholar
  26. 26.
    Choumon B, Ritz A, Corbet E et al (2002) Agénésie unilatérale d’avant-bras et prothétisation: mise en regard des représentations de parents et de professionnels. Rev Chir Orthop 88:117–124PubMedGoogle Scholar
  27. 27.
    Czeizel A, Kodaj I, Lenz W (1994) Smoking during pregnancy and congenital limb deficiency. Br Med J 308:1473–1476Google Scholar
  28. 28.
    Froster UG, Baird PA (1992) Congenital defects of the limbs and alcohol exposure in pregnancy: data from a population based study. Am J Med Genet 44:782–785PubMedCrossRefGoogle Scholar
  29. 29.
    Holmes LB (2002) Teratogen-induced limb defects. Am J Med Genet 112:297–303PubMedCrossRefGoogle Scholar
  30. 30.
    Hooper G (2000) Functional prostheses. In: Gupta et al (eds) The growing hand. Mosby, St. Louis, pp 1075–1078Google Scholar
  31. 31.
    Pillet J (2000) Esthetic prostheses. In: Gupta et al (eds) The growing hand. Mosby, St. Louis, pp 1079–1090Google Scholar
  32. 32.
    Scotland TR, Galway HR (1983) A long-term review of children with congenital and acquired upper limb deficiency. J Bone Joint Surg Br 65:346–349PubMedGoogle Scholar
  33. 33.
    Jain S (1996) Rehabilitation in limb deficiency: II. The pediatric amputee. Arch Phys Med Rehabil 77:S9–S13PubMedCrossRefGoogle Scholar
  34. 34.
    Mark TJ, Phillip EW (1992) Congenital anomalies of hand. In: Crenshaw AH (ed) Campbell’s operative orthopaedics. Mosby-Year Book, St. Louis 5:3353–3425Google Scholar
  35. 35.
    Muzaffar AR (2003) Hand V: fractures and dislocations; the wrist; congenital anomalies. Selected Readings in Plastic Surgery 9:1–56Google Scholar
  36. 36.
    Kozin SH (2003) Upper-extremity congenital anomalies. J Bone Joint Surg Am 85:1564–1575PubMedGoogle Scholar
  37. 37.
    Schwabe GC, Mundlos S (2004) Genetics of congenital anomalies. Handchir Mikrochir Plast Chir 36:85–97PubMedCrossRefGoogle Scholar
  38. 38.
    Daluiski A, Yi SE, Lyons KM (2001) The molecular control of upper extremity development: implications for congenital hand anomalies. J Hand Surg [Am] 26:8–22CrossRefGoogle Scholar
  39. 39.
    Britto J, Chan J, Evans R et al (2001) Differential expression of FGF receptors in human digital development suggests common pathogenesis in complex acrosyndactyly & craniosynostosis. Plast Reconstr Surg 107:1331–1338PubMedCrossRefGoogle Scholar
  40. 40.
    Tonkin MA (2004) An introduction to congenital hand anomalies. Handchir Mikrochir Plast Chir 36:75–84PubMedCrossRefGoogle Scholar
  41. 41.
    Cohn MJ, Bright PE (1999) Molecular control of vertebrate limb development, evolution and congenital malformations. Cell Tissue Res 296:3–17PubMedCrossRefGoogle Scholar
  42. 42.
    Choumon B, Fischer S, Gréco J, Ritz A, Bérard C (2006) Parcours devie d’adultes présentant une agénésie unilatérale d’avant-bras: enjeux et incidence du recours à la prothèse sur l’image de soi et les relations sociales. Rev Chir Orthop 92:27–32PubMedGoogle Scholar
  43. 43.
    Datta D, Selvarajah K, Davey N (2004) Functional outcome of patients with proximal upper limb deficiency — acquired and congenital. Clin Rehab 18:172–177CrossRefGoogle Scholar
  44. 44.
    Dubert T, Voche P, Dumontier C, Dinh A (2001) [The DASH questionnaire. French translation of a transcultural adaptation]. Chir Main 20:294–302PubMedCrossRefGoogle Scholar
  45. 45.
    Nicholas R (2005) Ethical considerations in allograft tissue transplantation: a surgeon’s perspective. Clin Orthop Relat Res 435:11–16PubMedCrossRefGoogle Scholar
  46. 46.
    Baumeister S, Kleist C, Dohler B et al (2004) Risks of allogeneic hand transplantation. Microsurgery 20:98–103CrossRefGoogle Scholar
  47. 47.
    Brenner MJ, Tung TH, Jensen JN, Mackinnon SE (2002) The spectrum of complications of immunosuppression: is the time right for hand transplantation? J Bone Joint Surg Am 84:1861–1870PubMedGoogle Scholar
  48. 48.
    Breidenbach WC, Tobin GR, Gorantla VS et al (2002) A position statement in support of hand transplantation. J Hand Surg [Am] 27:760–770CrossRefGoogle Scholar
  49. 49.
    Auchincloss H Jr (2001) In search of the elusive Holy Grail: the mechanisms and prospects for achieving clinical transplantation tolerance. Am J Transplant 1:6–12PubMedCrossRefGoogle Scholar
  50. 50.
    Morrow WR, Chinnock RE (2000) Survival after heart transplantation. In: Tejani et al (eds) Pediatric solid organ transplantation. Munksgaard, Copenhagen, pp 417–426Google Scholar
  51. 51.
    West LJ (2002) Developmental aspects of immunomodulation: exploiting the immature immune system for organ transplantation. Transpl Immunol 9:149–153PubMedCrossRefGoogle Scholar
  52. 52.
    West LJ (2002) Defining critical windows in the development of the human immune system. Hum Exp Toxicol 21:499–505PubMedCrossRefGoogle Scholar
  53. 53.
    Holan V (1990) Absolute specificity of neonatally induced transplantation tolerance. Transplantation 50:1072–1074PubMedCrossRefGoogle Scholar
  54. 54.
    Butler PE, Lee WP, van de Water AP, Randolph MA (2000) Neonatal induction of tolerance to skeletal tissue allografts without immunosuppression. Plast Reconstr Surg 105:2424–2430PubMedCrossRefGoogle Scholar
  55. 55.
    Petit F, Minns AB, Nazzal JA et al (2004) Prolongation of skin allograft survival after neonatal injection of donor bone marrow and epidermal cells. Plast Reconstr Surg 113:270–276PubMedCrossRefGoogle Scholar
  56. 56.
    Siemionow M, Ozer K (2002) Advances in composite tissue allograft transplantation as related to the hand and upper extremity. J Hand Surg [Am] 27:565–580CrossRefGoogle Scholar
  57. 57.
    Webber SA, Boyle GJ, Law YM et al (2003) A clinical trial of intrathymic inoculation of donor bone marrow with pediatric heart transplantation. Am J Transplant 3(S5):167Google Scholar
  58. 58.
    Guenther DA, Madsen JC (2005) Advances in strategies for inducing central tolerance in organ allograft recipients. Pediatr Transplant 9:277–281PubMedCrossRefGoogle Scholar
  59. 59.
    Petit F, Lantieri L, Randolph MA, Lee WP (2006) Les voies de recherche en immunologie appliquées à l’allotransplantation de tissus composites. Ann Chir Plast Esth 51:11–17CrossRefGoogle Scholar
  60. 60.
    Kirk AD (2003) Crossing the bridge: large animal models in translational transplantation research. Immunol Rev 196:176–196PubMedCrossRefGoogle Scholar
  61. 61.
    Jain S, Lakhtakia PK (2002) Profile of congenital transverse deficiencies among cases of congenital orthopaedic anomalies. J Orthop Surg 10:45–52Google Scholar
  62. 62.
    Giraux P, Sirigu A, Schneider F, Dubernard JM (2001) Cortical reorganization in motor cortex after graft of both hands. Nat Neurosci 4:691–692PubMedCrossRefGoogle Scholar
  63. 63.
    Brenneis C, Loscher WN, Egger KE et al (2005) Cortical motor activation patterns following hand transplantation and replantation. J Hand Surg [Br] 30:530–533CrossRefGoogle Scholar
  64. 64.
    Farne A, Roy AC, Giraux P et al (2002) Face or hand, not both: perceptual correlates of reafferentation in a former amputee. Curr Biol 12:1342–1346PubMedCrossRefGoogle Scholar
  65. 65.
    Mogilner A, Grossman JA, Ribary U et al (1993) Somatosensory cortical plasticity in adult humans revealed by magnetoencephalography. Proc Natl Acad Sci USA 90:3593–3597PubMedCrossRefGoogle Scholar
  66. 66.
    Pearson J, Pytel BA (1981) Neuronal survival and peripheral tissue size during human embryogenesis: study of a partial twinning. Dev Neurosci 4:142–149PubMedGoogle Scholar
  67. 67.
    Wetts R, Vaughn JE (1998) Peripheral and central target requirements for survival of embryonic rat dorsal ganglion neurons in slice cultures. J Neurosci 18:6905–6913PubMedGoogle Scholar
  68. 68.
    Caldero J, Prevette D, Mei X et al (1998) Peripheral target regulation of the development and survival of spinal sensory and motor neurons in the chick embryo. J Neurosci 18:356–370PubMedGoogle Scholar
  69. 69.
    Stoeckel MC, Jörgens S, Witte OW, Seitz RJ (2005) Reduced somatosensory hand representation in thalidomide-induced dysmelia as revealed by fMRI. Eur J Neurosci 21:556–562PubMedCrossRefGoogle Scholar
  70. 70.
    Stoeckel MC, Pollok B, Witte OW et al (2005) Shrinkage of somatosensory hand area in subjects with upper extremity dysmelia revealed by magnetoencephalography. J Neurophysiol 93:813–818PubMedCrossRefGoogle Scholar
  71. 71.
    Melzack R (1998) Possible phantom pain for childhood extremity aplasia. Fortschr Neurol Psychiatr 66(1):6 [German]Google Scholar
  72. 72.
    Wilkins KL, McGrath PJ, Finley GA, Katz J (1998) Phantom limb sensations & phantom limb pain in child & adolescent amputees. Pain 78:7–12PubMedCrossRefGoogle Scholar
  73. 73.
    Boonstra AM, Rijnders LJ, Groothoff JW, Eisma WH (2000) Children with congenital deficiencies or acquired amputations of the lower limbs: functional aspects. Prosthet Orthot Int 24:19–27PubMedGoogle Scholar
  74. 74.
    Price EH (2006) A critical review of congenital phantom limb cases & a developmental theory for the basis of body image. Conscious Cogn [In press]Google Scholar
  75. 75.
    Gilbert A (1982) Toe transfers for congenital hand defects. J Hand Surg [Am] 7:118–124Google Scholar
  76. 76.
    Lister G (1988) Microsurgical transfer of the second toe for congenital deficiency of the thumb. Plast Reconstr Surg 82:658–665PubMedCrossRefGoogle Scholar
  77. 77.
    Eaton CJ, Lister GD (1991) Toe transfer for congenital hand defects. Microsurgery 12:186–195PubMedCrossRefGoogle Scholar
  78. 78.
    Foucher G, Moss ALH (1991) Microvascular second toe to finger transfer: a statistical analysis of 55 transfers. Br J Plast Surg 44:87–90PubMedCrossRefGoogle Scholar
  79. 79.
    Vilkki S (1995) Advances in microsurgical reconstruction of the congenitally adactylous hand. Clin Orthop 314:45–58PubMedGoogle Scholar
  80. 80.
    Van Holder C, Giele H, Gilbert A (1999) Double second toe transfer in congenital hand anomalies. J Hand Surg [Br] 24:471–475CrossRefGoogle Scholar
  81. 81.
    Wei FC, Jain V, Chen SHT (2003) Toe-to-hand transplantation. Hand Clin 19:165–175PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Aram Gazarian
    • 1
  • Davit O. Abrahamyan
    • 1
  1. 1.Clinique du ParcLyonFrance

Personalised recommendations