-: My particular area of interest in medicine and
hand surgery is extremity reconstruction.
Because I trained in plastic surgery after orthopedics
and was Chief of the Division of Plastic Surgery at Duke
for almost 15 years, before I became Chairman of Orthopedics
here, I've sort of combined orthopedics and plastic surgery
into a specialty called Orthoplastic Surgery.
Part of that is a heavy reliance on the tools
and the techniques of microvascular surgery,
which is the coaptation or sewing together of
small vessels, small blood vessels, under the microscope.
Somebody amputates their finger,
we reattach is using the microscope.
Most of the patients we see, for consideration of hand
transplantation, have sustained a severe illness, usually
infection and because of the drugs that the patients were
put on to sustain them, to keep them alive, the peripheral
tissues, the hands and the feet, the arms and the legs,
lose their blood supply and become necrotic, they die.
So, patients require amputations and the patients that we
looked at are what we call quadrimembral amputees.
That means they have no arms or legs.
In 1998, the first hand transplantation
was done in the world, in France.
It was a technical success but a clinical failure.
In 1999, the first patient was operated on in
the United States by a colleague of mine and
one of my mentors from Louisville, Warren Breidenbach.
And that patient still has his hand today.
He's a public figure, his name is Matt Scott.
So, fast forward with my keen interest in
microvascular surgery and the evolution of reconstructive
surgery, I got interested in hand transplantation
and, was unsuccessful despite my research work at
Duke and enthusiasm for taking this new dimension of
reconstructive surgery and bringing
it to the reality in an institution.
I came to Penn in 2009, unsuccessful at Duke, and
within two years, we did our first hand
transplant with the support of the institution,
and a cast of my partners and orthopedics and plastic
surgery and transplant surgery and nursing and anesthesia.
It was sort of, it takes a village, to use the cliche.
So, we did our first transplant
in 2011, after two years of preparation.
Then, the world's first hand transplant in a child,
was done in 15 and a year later, we did another bilateral
lady, our first international patient that's ever been
transplanted sort of across the pond.
She came from Paris, France to us and
we have several other patients, both adults
and children now, that we're evaluating.