Tuesday, January 26, 1999
Hand transplanted in Louisville
1st procedure in U.S. shows promise
BY JOHN SCHWARTZ
The Washington Post
Surgeons in Kentucky on Monday completed the first hand transplant ever attempted in the United States, attaching the left hand from a cadaver to the arm of a New Jersey man maimed in a firecracker accident 13 years ago.
The transplanted hand became pink and showed very preliminary signs that the connected blood vessels were doing their job after the 15-hour operation at Louisville Medical Center. But doctors cautioned that it was far too early to tell whether the procedure was a success or how much use the recipient, Matthew David Scott, 37, would attain.
“In an ideal situation he would be able to make a fist,” said Warren C. Breidenbach, who led the Louisville surgical team. “He would be able to pick up a tennis ball, pick up a glass, or open a door.”
Dr. Breidenbach stressed, however, that “it would not be a normal hand.” Mr. Scott will probably never button his shirt collar with that hand, or use its fingers to pick up a penny.
The operation prompted criticism from other experts in the field who questioned whether the benefits outweigh the substantial risks. Mr. Scott will have to take powerful, potentially dangerous anti-rejection drugs for the rest of his life.
Doctors rushed Mr. Scott into surgery Sunday night when the donor's hand became available. A special tourniquet stopped blood flow to his arm, which was dissected to the bone. Doctors connected the arm's exposed bones to those on the donor hand with metal plates. They then attached the tendons, testing each flexor tendon with a tug that twitches a finger. The surgeons stitched tiny nerves together under powerful microscopes, and then the arteries and the veins.
After those connections were completed, the doctors released the tourniquet and made sure blood was flowing through the vessels before closing the skin.
Organ transplants have become almost commonplace, but medical experts say hands present special problems because they are comprised of so many different types of tissue. A team from Louisville's Jewish Hospital, the private hand surgery practice Kleinert, Kutz and Associates, and the University of Louisville performed the surgery. The group, which has been working toward this procedure for three years, included reconstructive and transplant surgeons, immunologists, pathologists, pharmacologists, psychologists and basic science researchers.
The Louisville team announced last year that it would perform a hand transplant but was beaten by an international team of surgeons in France who in September attached a cadaver's hand to the forearm of Clint Hallam, 48, an Australian. Mr. Hallam has gained some movement in the hand.
Mr. Scott, who is left-handed, is married and has two children. He is clinical coordinator for Virtua Health System in Gibbsboro, N.J., and assistant director for a paramedic training program at New Jersey's Camden County College. He had functioned for years with a prosthetic hand, but like many such patients was not satisfied with the results.
The surgery renewed medical debate over the advisability of attempting such procedures.
“Yes, we need to be doing this kind of surgery — that's clear cut,” said Vincent R. Hentz of Stanford University Medical School, president of the American Society for Surgery of the Hand. “The real question is, is now the proper time for this kind of procedure?”
Dr. Hentz said that surgical techniques and the drugs for immune system suppression have not improved markedly over 10 years, but both are expected to jump forward in the near future. “Why not wait until this next generation, since the target audience for all this are basically well people? They have lost something, but they are not ill.”
Mr. Scott's anti-rejection drugs can cause widespread side effects that include high blood pressure, increased risk of infection, diabetes, damage to the liver and kidneys, increased risk of cancers and hand tremors. The doctors are using less aggressive dosing than they would for other organ transplants, reducing the risk of drug damage but raising the potential for Mr. Scott's body to reject the hand.
Dr. Breidenbach said Mr. Scott was chosen because he had not adapted well to his artificial hand and is intelligent, articulate and has plenty of support from his family.
In an interview videotaped before his surgery, Mr. Scott said that with his artificial hand he lived in fear of going through buffet lines and handling food at parties. Nor was he able to show his sons how to play baseball, he said.
“It's always been the little things — the daily little things,” Mr. Scott said.
Is there room for strangers in our homes?
St. Louis swells for Pope's arrival
The pope's schedule
I-75 gas spill should be cleared by morning rush
Riverfront commission ready top go
Cincinnati Riverfront Advisory Commission
West plan falls short of wishes
West plan's details
Western residents, county split on development plan
Conductor Shaw called a giant of choral music
Man charged with setting home on fire
N.Ky. loses educators convention
Tax foes to battle increase for schools
Mourners make trend of wake
Actress comfy with role in 'Couch'
Colognes, perfumes can take your breath away - really
Etiquette for the over-perfumed
Ft. Washington Way closed next two nights
Hand transplanted in Louisville
2 plead guilty in slaying
Aquarium signs get attention
Beating death examined
Butler already owns favored site for jail
Covington divided over street widening
Custody war brings sea of legal paper
Developers are building 2-acre park in Blue Ash
Dogs, cats give elderly a boost
Eastgate area park-and-ride premieres
Fort Wright settles claim
Inclusion of disabled lauded
Lebanon activist's traffic-death trial to start today
Middletown sprucing up parks
Music museum picks up pace
Prison guard waives drug case hearing
Safety work will close Ohio 73
Time running out for Ky. GOP
TRISTATE DIGEST Asthma attack kills Lebanon prisoner
Trustees expected to approve contract with UC professors
