Skip to main content

Limb Transplantation in Congenital Deformities

  • Chapter
Hand Transplantation

Abstract

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].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Kelikian H (1974) Congenital deformities of the hand and forearm. WB Saunders, Philadelphia

    Google Scholar 

  2. Lundborg G (2000) Tomorrow’s artificial hand. Scand J Plast Reconstr Surg Hand Surg 34:97–100

    Article  PubMed  CAS  Google Scholar 

  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 105:2467–2481

    Article  PubMed  CAS  Google Scholar 

  4. Eppley BL (2001) Paediatric plastic surgery revisited. Clin Plast Surg 28:731–444

    PubMed  CAS  Google Scholar 

  5. Breuer C, Anthony T, Fong P (2004) Potential tissueengineering applications for neonatal surgery. Semin Perinatol 28:164–173

    Article  PubMed  Google Scholar 

  6. Chong AK, Chang J (2006) Tissue engineering for the hand surgeon: a clinical perspective. J Hand Surg [Am] 31:349–358

    Article  Google Scholar 

  7. Dubernard JM, Owen E, Herzberg G et al (1999) Première transplantation de main chez l’homme. Résultats précoces. Chir 124:358–365

    Article  CAS  Google Scholar 

  8. Dubernard JM, Owen E, Herzberg G et al (1999) Human hand allograft: report on first 6 months. Lancet 353:1315–1320

    Article  PubMed  CAS  Google Scholar 

  9. Petit F, Paraskevas A, Garrido I, Lantieri L (2005) La transplantation est-elle l’avenir de la microchirurgie? Ann Chir Plast Esth 50:76–79

    Article  CAS  Google Scholar 

  10. Hettiaratchy S, Randolph MA, Petit F et al (2004) Composite tissue allotransplantation — a new era in plastic surgery? Br J Plast Surg 57:381–391

    Article  PubMed  Google Scholar 

  11. Petit F (2002) Allotransplantation de tissus composites et chirurgie réparatrice. Les premières applications cliniques. Maîtrise Orthopédique 111. www.maitrise-orthop.com

    Google Scholar 

  12. Swanson AB (1976) A classification for congenital limb malformations. J Hand Surg [Am] 1:8–22

    CAS  Google Scholar 

  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 1489–1491

    Google Scholar 

  14. www.handregistry.com/default_noflash/English/Info_for_Patients/Causes_of_Hand_Loss/causes_of_hand_loss.html

    Google Scholar 

  15. Foucher G (1999) Commentary: prospects for hand transplantation. Lancet 353:1286–1287

    Article  PubMed  CAS  Google Scholar 

  16. Lundborg G (1999) Hand transplantation. Scand J Plast Reconstr Surg 33:369–371

    Article  CAS  Google Scholar 

  17. Manske PR (2001) Hand transplantation. J Hand Surg [Am] 26:193–195

    Article  CAS  Google Scholar 

  18. Jones NF (2002) Concerns about human hand transplantation in the 21st century. J Hand Surg [Am] 27:771–787

    Article  Google Scholar 

  19. Lees VC, McCabe SJ (2002) The rationale for hand transplantation. Transplantation 74:749–753

    Article  PubMed  CAS  Google Scholar 

  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 200:6–11

    Google Scholar 

  21. Mertes K (2006) Personal communication

    Google Scholar 

  22. Peillon B (2006) Personal communication

    Google Scholar 

  23. McCarroll HR (2000) Congenital anomalies: a 25-year overview. J Hand Surg [Am] 25:1007–1037

    CAS  Google Scholar 

  24. McGuirk CK, Westgate M-N, Holmes LB (2001) Limb deficiencies in newborn infants. Pediatrics 108:E64

    Article  PubMed  CAS  Google Scholar 

  25. Apkon S (2004) Pediatric limb deficiencies. PM&R Update 8:1–4

    Google Scholar 

  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 88:117–124

    PubMed  CAS  Google Scholar 

  27. Czeizel A, Kodaj I, Lenz W (1994) Smoking during pregnancy and congenital limb deficiency. Br Med J 308:1473–1476

    CAS  Google Scholar 

  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 44:782–785

    Article  PubMed  CAS  Google Scholar 

  29. Holmes LB (2002) Teratogen-induced limb defects. Am J Med Genet 112:297–303

    Article  PubMed  Google Scholar 

  30. Hooper G (2000) Functional prostheses. In: Gupta et al (eds) The growing hand. Mosby, St. Louis, pp 1075–1078

    Google Scholar 

  31. Pillet J (2000) Esthetic prostheses. In: Gupta et al (eds) The growing hand. Mosby, St. Louis, pp 1079–1090

    Google Scholar 

  32. Scotland TR, Galway HR (1983) A long-term review of children with congenital and acquired upper limb deficiency. J Bone Joint Surg Br 65:346–349

    PubMed  CAS  Google Scholar 

  33. Jain S (1996) Rehabilitation in limb deficiency: II. The pediatric amputee. Arch Phys Med Rehabil 77:S9–S13

    Article  PubMed  CAS  Google Scholar 

  34. Mark TJ, Phillip EW (1992) Congenital anomalies of hand. In: Crenshaw AH (ed) Campbell’s operative orthopaedics. Mosby-Year Book, St. Louis 5:3353–3425

    Google Scholar 

  35. Muzaffar AR (2003) Hand V: fractures and dislocations; the wrist; congenital anomalies. Selected Readings in Plastic Surgery 9:1–56

    Google Scholar 

  36. Kozin SH (2003) Upper-extremity congenital anomalies. J Bone Joint Surg Am 85:1564–1575

    PubMed  Google Scholar 

  37. Schwabe GC, Mundlos S (2004) Genetics of congenital anomalies. Handchir Mikrochir Plast Chir 36:85–97

    Article  PubMed  CAS  Google Scholar 

  38. Daluiski A, Yi SE, Lyons KM (2001) The molecular control of upper extremity development: implications for congenital hand anomalies. J Hand Surg [Am] 26:8–22

    Article  CAS  Google Scholar 

  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 107:1331–1338

    Article  PubMed  CAS  Google Scholar 

  40. Tonkin MA (2004) An introduction to congenital hand anomalies. Handchir Mikrochir Plast Chir 36:75–84

    Article  PubMed  CAS  Google Scholar 

  41. Cohn MJ, Bright PE (1999) Molecular control of vertebrate limb development, evolution and congenital malformations. Cell Tissue Res 296:3–17

    Article  PubMed  CAS  Google Scholar 

  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 92:27–32

    PubMed  CAS  Google Scholar 

  43. Datta D, Selvarajah K, Davey N (2004) Functional outcome of patients with proximal upper limb deficiency — acquired and congenital. Clin Rehab 18:172–177

    Article  Google Scholar 

  44. Dubert T, Voche P, Dumontier C, Dinh A (2001) [The DASH questionnaire. French translation of a transcultural adaptation]. Chir Main 20:294–302

    Article  PubMed  CAS  Google Scholar 

  45. Nicholas R (2005) Ethical considerations in allograft tissue transplantation: a surgeon’s perspective. Clin Orthop Relat Res 435:11–16

    Article  PubMed  Google Scholar 

  46. Baumeister S, Kleist C, Dohler B et al (2004) Risks of allogeneic hand transplantation. Microsurgery 20:98–103

    Article  Google Scholar 

  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 84:1861–1870

    PubMed  Google Scholar 

  48. Breidenbach WC, Tobin GR, Gorantla VS et al (2002) A position statement in support of hand transplantation. J Hand Surg [Am] 27:760–770

    Article  Google Scholar 

  49. Auchincloss H Jr (2001) In search of the elusive Holy Grail: the mechanisms and prospects for achieving clinical transplantation tolerance. Am J Transplant 1:6–12

    Article  PubMed  Google Scholar 

  50. Morrow WR, Chinnock RE (2000) Survival after heart transplantation. In: Tejani et al (eds) Pediatric solid organ transplantation. Munksgaard, Copenhagen, pp 417–426

    Google Scholar 

  51. West LJ (2002) Developmental aspects of immunomodulation: exploiting the immature immune system for organ transplantation. Transpl Immunol 9:149–153

    Article  PubMed  CAS  Google Scholar 

  52. West LJ (2002) Defining critical windows in the development of the human immune system. Hum Exp Toxicol 21:499–505

    Article  PubMed  CAS  Google Scholar 

  53. Holan V (1990) Absolute specificity of neonatally induced transplantation tolerance. Transplantation 50:1072–1074

    Article  PubMed  CAS  Google Scholar 

  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 105:2424–2430

    Article  PubMed  CAS  Google Scholar 

  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 113:270–276

    Article  PubMed  Google Scholar 

  56. Siemionow M, Ozer K (2002) Advances in composite tissue allograft transplantation as related to the hand and upper extremity. J Hand Surg [Am] 27:565–580

    Article  Google Scholar 

  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):167

    Google Scholar 

  58. Guenther DA, Madsen JC (2005) Advances in strategies for inducing central tolerance in organ allograft recipients. Pediatr Transplant 9:277–281

    Article  PubMed  Google Scholar 

  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 51:11–17

    Article  CAS  Google Scholar 

  60. Kirk AD (2003) Crossing the bridge: large animal models in translational transplantation research. Immunol Rev 196:176–196

    Article  PubMed  CAS  Google Scholar 

  61. Jain S, Lakhtakia PK (2002) Profile of congenital transverse deficiencies among cases of congenital orthopaedic anomalies. J Orthop Surg 10:45–52

    Google Scholar 

  62. Giraux P, Sirigu A, Schneider F, Dubernard JM (2001) Cortical reorganization in motor cortex after graft of both hands. Nat Neurosci 4:691–692

    Article  PubMed  CAS  Google Scholar 

  63. Brenneis C, Loscher WN, Egger KE et al (2005) Cortical motor activation patterns following hand transplantation and replantation. J Hand Surg [Br] 30:530–533

    Article  CAS  Google Scholar 

  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 12:1342–1346

    Article  PubMed  CAS  Google Scholar 

  65. Mogilner A, Grossman JA, Ribary U et al (1993) Somatosensory cortical plasticity in adult humans revealed by magnetoencephalography. Proc Natl Acad Sci USA 90:3593–3597

    Article  PubMed  CAS  Google Scholar 

  66. Pearson J, Pytel BA (1981) Neuronal survival and peripheral tissue size during human embryogenesis: study of a partial twinning. Dev Neurosci 4:142–149

    PubMed  CAS  Google Scholar 

  67. Wetts R, Vaughn JE (1998) Peripheral and central target requirements for survival of embryonic rat dorsal ganglion neurons in slice cultures. J Neurosci 18:6905–6913

    PubMed  CAS  Google Scholar 

  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 18:356–370

    PubMed  CAS  Google Scholar 

  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 21:556–562

    Article  PubMed  Google Scholar 

  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 93:813–818

    Article  PubMed  Google Scholar 

  71. Melzack R (1998) Possible phantom pain for childhood extremity aplasia. Fortschr Neurol Psychiatr 66(1):6 [German]

    Google Scholar 

  72. Wilkins KL, McGrath PJ, Finley GA, Katz J (1998) Phantom limb sensations & phantom limb pain in child & adolescent amputees. Pain 78:7–12

    Article  PubMed  CAS  Google Scholar 

  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 24:19–27

    PubMed  CAS  Google Scholar 

  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. Gilbert A (1982) Toe transfers for congenital hand defects. J Hand Surg [Am] 7:118–124

    CAS  Google Scholar 

  76. Lister G (1988) Microsurgical transfer of the second toe for congenital deficiency of the thumb. Plast Reconstr Surg 82:658–665

    Article  PubMed  CAS  Google Scholar 

  77. Eaton CJ, Lister GD (1991) Toe transfer for congenital hand defects. Microsurgery 12:186–195

    Article  PubMed  CAS  Google Scholar 

  78. Foucher G, Moss ALH (1991) Microvascular second toe to finger transfer: a statistical analysis of 55 transfers. Br J Plast Surg 44:87–90

    Article  PubMed  CAS  Google Scholar 

  79. Vilkki S (1995) Advances in microsurgical reconstruction of the congenitally adactylous hand. Clin Orthop 314:45–58

    PubMed  Google Scholar 

  80. Van Holder C, Giele H, Gilbert A (1999) Double second toe transfer in congenital hand anomalies. J Hand Surg [Br] 24:471–475

    Article  Google Scholar 

  81. Wei FC, Jain V, Chen SHT (2003) Toe-to-hand transplantation. Hand Clin 19:165–175

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer-Verlag Italia

About this chapter

Cite this chapter

Gazarian, A., Abrahamyan, D.O. (2007). Limb Transplantation in Congenital Deformities. In: Lanzetta, M., Dubernard, JM., Petruzzo, P. (eds) Hand Transplantation. Springer, Milano. https://doi.org/10.1007/978-88-470-0374-3_55

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-0374-3_55

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0373-6

  • Online ISBN: 978-88-470-0374-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics