|
The story of this book is quite simple: after the
first few hand transplants, we felt the need to have
regular meetings so that our clinical experiences
would be beneficially shared and serve as a basis
to draw some guidelines for the future. In so
doing, we soon realised that a huge amount of
original clinical data and information was becoming
available as we were proceeding with our operations
and closely following our patients’ progress
and functional outcomes. Some of these data were
reported in scientific articles, but to group them in
a comprehensive book seemed the best way to
provide a complete review of this pioneering
work.
Since starting our hand transplantation programmes,
we often felt we were exploring a new
area of surgery without the possibility or comfort
of referring to already published work to support
our own decisions. Indeed, some aspects of hand
transplantation required prompt decisions based
solely on personal interpretation of presenting
clinical scenarios. New techniques were introduced
to address different needs, such as the
analysis of brain remodeling using functional
magnetic resonance imaging or the use of a sensory
glove to precondition the patient or accelerate
the recovery of sensibility. Original work included
creation of a specific consent form for patients,
psychological tests for candidates and a comprehensive
scoring system for assessing clinical outcome.
There was the need to establish a grading
system to evaluate acute skin rejection and clear
criteria to select ideal candidates. From a legal
point of view, there were no criteria for dealing
with persons carrying two different sets of fingerprints.
From an insurance perspective, there were
no criteria as to how the disability of these
patients would be revaluated after the hand transplant.
Clinically, the most challenging issues have
been identifying the best immunosuppressive
drug regime and understanding how acute rejection
develops and how to reverse it.Use of an additional
distant skin island allograft resulted in better
rejection monitoring, at the same time avoiding
the need to take multiple biopsies from the
hand. Nerve regrowth and excellent
sensibility/motor recovery was one of the most
important results in hand transplantation, and
leading experts in peripheral nerve regeneration
suggest a scientific explanation. Rehabilitation of
the transplanted hand has been very demanding
for both therapists and patients, and specific protocols
had to be implemented.
As the hand is only one of the composite tissues
currently transplanted in order to correct disabilities
or deformities, we include chapters on all the other
types of non-life-saving allografts, including the
face,knee joint,uterus, abdominal wall and larynx.
We are honoured to have such a great number
of internationally renowned personalities share
their experience and knowledge in this book; their
contributions have made it the most complete
work available on hand and other composite tissue
allografts. We hope it will serve as a useful
guide for those desiring to launch their own composite
tissue transplantation programmes or to
those who simply wish to read about the current
state of the art of this new and exciting field. |