This program, which would be the 11th in the nation, builds on a
long-standing history of successful replantation, or reattachment,
of amputated digits, hands and upper extremities by the plastic and
reconstructive hand surgeons at SIU, said Dr. Michael W. Neumeister.
He is professor and chair of SIU's Department of Surgery, Elvin G.
Zook Endowed Chair in Plastic Surgery, and surgical director of the
Hand Transplant Program at SIU School of Medicine.
The Memorial Medical Center Foundation provided a $2.8 million
grant to establish the program. The grant is expected to cover the
majority of costs for up to five patients over three years.
Between 6,000 and 10,000 upper extremity amputations occur each
year in the United States, and over 1,200 soldiers have lost a limb
as a result of explosions in Iraq and Afghanistan. It is estimated
that over 1.3 million people in the United States currently have
some form of amputation.
Since microsurgery was initiated at SIU School of Medicine in the
early 1980s, plastic surgery has reattached many amputated fingers
and hands, Neumeister said. Unfortunately not all amputated limbs
are salvageable, and these patients are destined to live as amputees
with or without the use of various prosthetics. Although prosthetics
can be extremely useful, they do have their limitations, costs and
poor ability to provide sensation, he said.
The first long-term successful hand transplant was performed in
Louisville, Ky., in 1999. Nearly 100 hands have been subsequently
transplanted worldwide, with an overall five-year allograft survival
rate of around 90 percent, compared with 75 percent in kidney
Hand transplantation can be technically very challenging and may
last from 12 to 24 hours while bones, blood vessels, tendons,
muscles, nerves and skin are meticulously repaired, Neumeister said.
Patients subsequently require significant monitoring of their
immunosuppressive (anti-rejection) medications as well as intense
physical therapy to regain function of the transplanted upper
"Given the significant upper extremity trauma and number of
amputations treated by SIU Plastic Surgery as well as the experience
of transplantation at Memorial Medical Center, which has over 40
years of kidney/pancreas transplant experience, we are uniquely
qualified and poised to offer hand transplantation within the
Midwest," Neumeister said.
Hand transplantation is an option for people who have lost one or
both hands below the elbow and may even be beneficial for some
above-elbow amputees. The goal is to restore hand function and
sensation as well as a state of wholeness to the body.
It should only be considered by those who have attempted to use
prosthetics but continue to have significant disability despite
their use. Candidates for the procedure should also be in overall
good health and be willing to comply with the medication and
rehabilitation protocols after surgery.
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"Because these patients will be receiving a deceased person's
tissue, they will be similar to other transplant patients and
will require lifelong immunosuppression (anti-rejection)
medications," said Dr. Bradford West, medical director of SIU's
hand transplant program and chair of nephrology at Springfield
Clinic. West also serves as medical director of the Alan G.
Birtch, MD, Center for Pancreas and Kidney Transplant Program
and Surgery Services at Memorial Medical Center.
"In contrast to other organ transplant patients, there is an
added level of complexity to finding the right hand transplant donor
since additional matching criteria are required, such as gender,
ethnicity, skin color and tone, and size," said West. "Despite these
obstacles, there is a quality-of-life benefit that outweighs the
risks for some patients who desire a higher level of functioning and
a more natural look and feel."
The Hand Transplant Program is a multidisciplinary endeavor that
includes SIU School of Medicine, Memorial Transplant Services and
Springfield Clinic Transplant Nephrology. Team members include
plastic surgeons, transplant surgeons, orthopedic surgeons, and
specialists in transplant nephrology, infectious disease,
pharmacology, psychiatry, pathology, anesthesia, radiology,
neurology, ethics and hand therapy.
The success of the Hand Transplant Program will require
appropriate amputee candidates and donors of the limb to be
transplanted. All patients who receive a hand transplant will have
undergone extensive testing and matching to try to prevent
rejection, West said.
The overriding goal of the program is to return amputees to their
pre-amputation productive life without the need of a prosthetic
The SIU Hand Transplant Program is a research study that has been
approved by the Springfield Committee for Research Involving Human
Subjects (IRB 12-811). Patients who meet the basic eligibility
requirements and wish to be considered should contact the clinical
research coordinator at 1-855-SIU-HAND (1-855-748-4263) or
for an initial evaluation. For more information, see
[Text from file received from
Memorial Health System]