Hand Transplantation Versus Hand Prosthetics: Pros and Cons

Abstract

Composite tissue transplantation and new developments in the field of prosthetics have opened new frontiers in the restoration of function among upper limb amputees. It is now possible to restore hand function in affected patients; however, the indications, advantages, and limitations for either hand transplantation or prosthetic fitting must be carefully considered depending on the level and extent of the limb loss. Hand transplantation allows comprehensive hand function to be restored, yet composite tissue transplantation comes with disadvantages, making this method a controversial topic in the hand surgical community. Alternatively, prosthetic limb replacement represents the standard of care for upper limb amputees, but results in the known limitations of function, sensation, and usage. The indication for hand transplantation or prosthetic fitting strongly depends on the level of amputation, as well as on the extent (unilateral/bilateral) of the amputation. In this review, we discuss the advantages and disadvantages of hand transplantation and prosthetic replacement for upper limb amputees in general, as well as in regard to the different levels of amputation.

Bionic hand as artificial organ: Current status and future perspectives

“…A transplanted hand never runs out of battery. Another crucial superiority compared to bionic fitting is the sense of touch, which is still lacking in prostheses . Besides long and recurrent inpatient treatment, as well as long rehabilitation, the need for immunosuppression is the greatest limitation of transplantation.…”

“…Considering the costs of hand transplantation, including surgery, rehabilitation, and medication, as well as nonproductive time at work, bionic reconstruction is, by far, less expensive . The costs of transplantation exceed to such an extent the prosthetic solution, that the Swiss Health Care Association, for instance, declined transplantation as treatment option in favor of bionic reconstruction …”

“…As the peripheral nerve starts its regeneration with an axon outgrowth speed of about 1 mm/day from nerve coaptation site downward, the most distal muscles, such as the intrinsic hand muscles, atrophy, do not recover, and thereby remain functionless . Therefore, transplantation on a glenohumeral level (shoulder) has never been performed, as the reinnervation course would be even longer . This emphasizes the need for adequate bionic solutions for all levels of amputation.…”

“…This connection between man and machine is called prosthetic interface (Figure ). As coordinated contraction of 2 separate muscle groups (eg, agonist‐antagonist) is easy to learn for most patients, rehabilitation and prosthetic fitting can be performed early after amputation and in relatively short time until the patients get satisfying results . As the number of control signals directly corresponds to the degrees of freedom (DoF) the patient can perform with the prosthesis, a 2‐signal standard is promptly limited.…”

Transplants for non-lethal conditions: a case against hand transplantation in minors

“…Whether this complex procedure offers sufficient benefit over available alternatives, such as mechanical prosthetics that have been rapidly progressing in complexity and capabilities, remains an open question, but one that could be amenable to study 18. Nevertheless, even modern computer-assisted prosthetics are not without problems of their own, especially for those patients with above-the elbow limb loss, bilateral amputees and the like.…”