WEBVTT 1 00:00:00.000 --> 00:00:03.410 My particular area of interest in medicine and 2 00:00:03.410 --> 00:00:06.770 hand surgery is extremity reconstruction. 3 00:00:07.810 --> 00:00:10.670 line:15% Because I trained in plastic surgery after orthopedics 4 00:00:10.670 --> 00:00:13.390 line:15% and was Chief of the Division of Plastic Surgery at Duke 5 00:00:13.390 --> 00:00:17.080 line:15% for almost 15 years, before I became Chairman of Orthopedics 6 00:00:17.080 --> 00:00:19.930 line:15% here, I've sort of combined orthopedics and plastic surgery 7 00:00:19.930 --> 00:00:23.200 into a specialty called Orthoplastic Surgery. 8 00:00:23.200 --> 00:00:26.090 line:15% Part of that is a heavy reliance on the tools 9 00:00:26.090 --> 00:00:29.710 line:15% and the techniques of microvascular surgery, 10 00:00:29.710 --> 00:00:33.981 line:15% which is the coaptation or sewing together of 11 00:00:33.981 --> 00:00:38.410 small vessels, small blood vessels, under the microscope. 12 00:00:38.410 --> 00:00:39.810 Somebody amputates their finger, 13 00:00:39.810 --> 00:00:42.120 we reattach is using the microscope. 14 00:00:42.120 --> 00:00:46.010 Most of the patients we see, for consideration of hand 15 00:00:46.010 --> 00:00:50.540 transplantation, have sustained a severe illness, usually 16 00:00:50.540 --> 00:00:53.710 infection and because of the drugs that the patients were 17 00:00:53.710 --> 00:00:57.510 put on to sustain them, to keep them alive, the peripheral 18 00:00:58.455 --> 00:01:01.510 tissues, the hands and the feet, the arms and the legs, 19 00:01:01.510 --> 00:01:06.470 line:15% lose their blood supply and become necrotic, they die. 20 00:01:06.470 --> 00:01:10.020 line:15% So, patients require amputations and the patients that we 21 00:01:10.020 --> 00:01:13.510 line:15% looked at are what we call quadrimembral amputees. 22 00:01:13.510 --> 00:01:15.590 That means they have no arms or legs. 23 00:01:15.590 --> 00:01:18.830 In 1998, the first hand transplantation 24 00:01:18.830 --> 00:01:21.330 was done in the world, in France. 25 00:01:21.330 --> 00:01:25.020 It was a technical success but a clinical failure. 26 00:01:25.020 --> 00:01:28.350 In 1999, the first patient was operated on in 27 00:01:28.350 --> 00:01:30.770 the United States by a colleague of mine and 28 00:01:30.770 --> 00:01:34.270 one of my mentors from Louisville, Warren Breidenbach. 29 00:01:34.270 --> 00:01:36.820 And that patient still has his hand today. 30 00:01:36.820 --> 00:01:39.060 He's a public figure, his name is Matt Scott. 31 00:01:39.060 --> 00:01:42.030 So, fast forward with my keen interest in 32 00:01:42.030 --> 00:01:45.590 microvascular surgery and the evolution of reconstructive 33 00:01:45.590 --> 00:01:50.210 surgery, I got interested in hand transplantation 34 00:01:50.210 --> 00:01:54.830 and, was unsuccessful despite my research work at 35 00:01:54.830 --> 00:01:58.930 Duke and enthusiasm for taking this new dimension of 36 00:01:58.930 --> 00:02:00.360 line:15% reconstructive surgery and bringing 37 00:02:00.360 --> 00:02:03.220 line:15% it to the reality in an institution. 38 00:02:03.220 --> 00:02:08.220 line:15% I came to Penn in 2009, unsuccessful at Duke, and 39 00:02:08.520 --> 00:02:10.520 within two years, we did our first hand 40 00:02:10.520 --> 00:02:13.410 transplant with the support of the institution, 41 00:02:13.410 --> 00:02:16.380 and a cast of my partners and orthopedics and plastic 42 00:02:16.380 --> 00:02:19.090 surgery and transplant surgery and nursing and anesthesia. 43 00:02:19.090 --> 00:02:23.100 It was sort of, it takes a village, to use the cliche. 44 00:02:23.100 --> 00:02:24.880 So, we did our first transplant 45 00:02:24.880 --> 00:02:28.800 in 2011, after two years of preparation. 46 00:02:28.800 --> 00:02:31.950 Then, the world's first hand transplant in a child, 47 00:02:31.950 --> 00:02:35.500 was done in 15 and a year later, we did another bilateral 48 00:02:35.500 --> 00:02:37.930 line:15% lady, our first international patient that's ever been 49 00:02:37.930 --> 00:02:40.540 line:15% transplanted sort of across the pond. 50 00:02:40.540 --> 00:02:42.490 line:15% She came from Paris, France to us and 51 00:02:42.490 --> 00:02:44.900 line:15% we have several other patients, both adults 52 00:02:44.900 --> 00:02:47.500 and children now, that we're evaluating.