New in Hand Surgery

Hand and Upper Extremity


General


What’s New in Hand Surgery


Amadio PC (Mayo Clinic, Rochester, MN) J Bone Joint Surg Am 92:783-789, 2010§



D.J. Smith, Jr., MD



Evidence Ranking


• C



Expert Rating


• 2



Abstract



Background


The presentations at the 2009 annual meetings of the American Society for Surgery of the Hand (ASSH), the American Association for Hand Surgery (AAHS), and the American Academy of Orthopaedic Surgeons (AAOS) offered updated information in several areas. The principal findings were briefly explained.



Trauma


War injuries involving hand amputations are receiving more attention. Innovative changes in upper limb prosthetics include targeted muscle reinnervation (TMR), in which nerves that served the amputated part are rerouted to new muscle sites. These reinnervated target muscles produce electromyographic signals that can control upper limb prostheses, producing more rapid and natural movements of the prosthetics.


Hand transplantation immunotherapy is more complex than for single-tissue organ transplantations. New immunosuppression regimens are being developed based on data from the first two hand transplantation patients, who report fair function 7 and 9 years post-transplantation. However, both have suffered episodes of rejection and other complications related to immunosuppressive medication. Skin is the primary target of rejection, and repetitive hand trauma can trigger a rejection episode. New strategies focus on reducing or intermittently eliminating immunosuppressive therapy, with the potential to greatly reduce morbidity. Post-transplant morbidity is also being more thoroughly assessed using a decision tree. A unilateral hand transplantation produces about 25 quality-adjusted life-years (QALYs) over a remaining lifespan of 40 years, and bilateral transplantation produces 22 QALYs; the transplantations would cost more than $700,000 per QALY. The QALYs for unilateral and bilateral amputations are estimated at 34 and 29 and cost per QALY is between $14,000 and $27,000. Prosthetic adaptation is therefore preferred over current hand transplantation techniques.

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May 5, 2016 | Posted by in Aesthetic plastic surgery | Comments Off on New in Hand Surgery

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