UT Southwestern surgeons to perform first hand transplant in North Texas

A team of surgeons at UT Southwestern Medical Center expects to perform the first hand transplant in North Texas within a year, making the institution just the sixth hospital in the U.S. to perform the rare and intricate surgery.

UT Southwestern received Institutional Review Board approval in July to move forward with the program. Transplant specialists are now screening potential patients who would likely tolerate anti-rejection medications and also endure intense physical therapy.

"This is the ultimate in reconstructive surgery. Nothing can provide the sensibility, the fine motor control and the strength that a transplanted hand can provide," said Dr. Tae Chong, assistant professor of plastic surgery at UT Southwestern, who will lead the team. "For these patients, the improvement is life-changing."

Patients who need a hand transplant typically have undergone some sort of trauma, such as a vehicle accident or severe burns. Recently, however, the largest influx of patients is injured military personnel.

"There have been incredible advances in battlefield armor, so they're coming back alive, but with severe and disabling trauma to their limbs," Dr. Chong said of the military. "Seventy percent of soldiers injured in combat have some extremity injury. Improvised explosive devices have changed the nature of combat-related injuries.

"We are well-versed in reconstructive surgery for the upper extremity," Dr. Chong noted. "Tendon, nerve, vascular, skin and bone reconstruction - this is something in which we all have extensive training and expertise. Plastic surgeons have been involved in transplant surgery from the start, when initial studies used skin grafts for burned soldiers in World War II."

Dr. Rod Rohrich, chairman of plastic surgery, said, "The timing is right for UT Southwestern to perform this innovative procedure. With the support and commitment of our university hospital system, and with the expertise of our transplant team and the addition of Dr. Chong, we are ready to develop and help the severely injured American veterans and patients so they can return as a functional person in our society."

More than 40 hand transplants have been recorded since the first was performed in 1998 in France, including a few double hand transplants in recent years. The first U.S. hand transplant was performed in 1999 in Louisville, Ky. Patients show a five-year success rate of about 92 percent to 95 percent.

During a transplant procedure, a team of up to 15 surgeons, anesthesiologists, operating room nurses and technicians will work simultaneously to prepare the donor hand and the recipient. As the donor limb is attached, hand and microvascular surgeons begin the complex work of attaching tendons, blood vessels and nerves. The operation typically lasts 10 to 14 hours.

Reattaching a severed limb is a complicated operation, Dr. Chong said. Chronic scarring can make it challenging to identify the more than 25 structures in the hand that need to be repaired to achieve functionality. But plastic surgeons are well-suited to perform the intricate work of transplant procedures, he added.

Dr. Chong completed two years of transplant research at the University of Virginia School of Medicine, where he studied immune suppression, infectious disease and transplants. He also became part of the hand transplant team at the University of Pittsburgh, where he trained in plastic and reconstructive surgery and assisted in both the recovery and transplantation process.