Hand transplantation is one of the ground-breaking innovations that the medical field has made possible via its tremendous advances. A hand transplant, also known as Vascularised Composite Allotransplantation (or VCA), involves replacing the hand entirely through surgery. Composite Tissue Allotransplantation (CTA) is another term occasionally used to describe this procedure. The two terms refer to structures within the hand that are connected after a transplant, such as blood arteries, nerves, cartilage, bone, tendon, skin, and muscle. 

When a disease or injury causes serious structural and functional deficiencies, a hand transplant may be considered. A hand transplant involves the patient receiving one or two donor hands as well as a section of a deceased person's forearms. A transplanted hand requires rehabilitation care after surgery, just like any other hand injury with nerve involvement. 

Hand Transplant at Gleneagles Hospitals 

Among India's leading healthcare institutions, Gleneagles Hospitals stands out as a premiere hand transplant hospital. The hospital has changed the lives of patients who were once faced with the miserable prospect of permanent hand impairment by performing numerous complex hand transplant surgeries with success. The hospital is equipped with modern amenities and a team of skilled surgeons who specialise in microsurgery and transplant procedures. 

Why is a Hand Transplant done? 

Hand transplantation is undertaken primarily to restore hand function and improve the quality of life for individuals who have lost one or both hands. Whether the loss occurred due to traumatic accidents, severe burns, congenital anomalies, or illnesses affecting hand function, this procedure offers a chance to regain the ability to perform daily tasks and activities. Many people who have lost a hand, or sometimes a whole arm, live and function successfully with the assistance of prostheses. However, if a prosthesis fails to function properly, transplantation of a new hand or arm may be considered. In cases when the patient meets all the requirements and the injury is too severe for common reconstructive surgery, the doctor may suggest a hand transplant. 

Who is not a good candidate? 

While hand transplantation offers immense potential, eligibility and indication for hand transplantation need to be evaluated comprehensively. 

• Indications may include amputation of the dominant hand, bilateral amputations, distal amputations, and abrupt amputations with clean end points of distal stump, among potential other indications. 

Before Hand Transplant Surgery 

Before the surgery, extensive assessments are conducted to evaluate the patient's overall health, psychological readiness, and compatibility for transplantation. A person who is scheduled to have hand transplant surgery will start strengthening their upper extremities via rehabilitation treatment. A comprehensive evaluation involves physical examinations, imaging studies, blood tests, and consultations with various specialists to ensure the patient's suitability and readiness for the procedure. 

To prepare the body for receiving the transplanted hand or hands, the patient will begin an immunosuppressive drug regimen. Clinic check-ins will be used to track their drug tolerance. Recipients are often encouraged to remain within several hours of the hospital where the transplant will be performed due to the duration and complexity of the hand transplant operation. 

During the Surgery 

The hand transplant surgery itself is a meticulously orchestrated procedure that involves a multidisciplinary team of surgeons, nurses, anesthesiologists, and support staff. A hand transplant requires the cooperation of two surgical teams. As the other gets ready to transplant the recipient's arm, one works on extracting and conserving the donor's hand or hands. 

The surgical process includes intricate microsurgical techniques to reconnect blood vessels, nerves, tendons, muscles, and bones. Surgeons join the blood vessels with extreme caution throughout the treatment and then thoroughly test them to ensure they function properly. After the blood arteries are safely fastened and tested, the surgeon will proceed to join muscles, tendons, bones, and nerves. A hand transplant can take eight to sixteen hours without challenges. 

After the Procedure 

After the procedure, the patient will stay in the Intensive Care Unit (ICU) for a few days. Immunosuppressive medications are prescribed to prevent the body from rejecting the transplanted hand. Intensive physical and occupational therapy sessions are initiated after the second day to help the recipient regain strength, mobility, and functionality in the transplanted hand. The pain levels will also be continuously watched since excessive discomfort might be a symptom of rejection. Patients frequently need to wear a splint to safeguard the mechanics of the hand when it is at rest. 

What are the risks of Hand Transplant? 

As with any major surgical procedure, hand transplantation carries inherent risks. The foremost concern is the possibility of the body rejecting the transplanted hand despite immunosuppressive medications. Acute and chronic rejection are the two types of rejection. Acute rejection occurs when the body perceives the transplanted limb as a foreign item, and the immune system fights it. This usually happens within the first few months. Chronic rejection occurs over time and can finally lead to failure. However, as long as the patient adheres to the immunosuppressive regimen indicated, there is evidence that excellent long-term results can be attained following a hand transplant. 

Blood clots, bleeding, and infection are also potential risks. Reduced blood supply to the hand due to a clot would be a major issue that would need to be repaired immediately with surgery. 

Prognosis 

The prognosis for hand transplantation varies from patient to patient. Several factors, such as the recipient's compliance with treatment and healing, compatibility with the donor tissue, and the body's reaction to the transplant, influence the procedure's outcome, even though many recipients report notable improvements in hand function and quality of life.