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Prosthetic Rehabilitation and Vascularized Composite Allotransplantation following Upper Limb Loss

Kubiak, Carrie A. M.D.; Etra, Joanna W. M.D.; Brandacher, Gerald M.D.; Kemp, Stephen W. P. Ph.D.; Kung, Theodore A. M.D.; Lee, W. P. Andrew M.D.; Cederna, Paul S. M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1688-1701
doi: 10.1097/PRS.0000000000005638
Hand/Peripheral Nerve: Special Topic
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Background: Upper limb loss is a devastating condition with dramatic physical, psychological, financial, and social consequences. Improvements in the fields of prosthetics and vascularized composite allotransplantation have opened exciting new frontiers for treatment and rehabilitation following upper limb loss. Each modality offers a unique set of advantages and limitations with regard to the restoration of hand function following amputation.

Methods: Presented in this article is a discussion outlining the complex considerations and decisions encountered when determining patient appropriateness for either prosthetic rehabilitation or vascularized composite allotransplantation following upper limb loss. In this review, the authors examine how psychosocial factors, nature of injury, rehabilitation course, functional outcomes, and risks and benefits may affect overall patient selection for either rehabilitative approach.

Results: This review summarizes the current state of the literature. Advancements in both prosthetic and biological strategies demonstrate promise with regard to facilitating rehabilitation following upper limb loss. However, there remains a dearth of research directly comparing outcomes in prosthetic rehabilitation to that following upper extremity transplantation.

Conclusions: Few studies have performed a direct comparison between patients undergoing vascularized composite allotransplantation and those undergoing prosthetic rehabilitation. Upper extremity transplantation and prosthetic reconstruction should not be viewed as competing options, but rather as two treatment modalities with different risk-to-benefit profiles and indications.

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Ann Arbor, Mich.; and Baltimore, Md.

From the Department of Surgery, Section of Plastic and Reconstructive Surgery, and the Department of Biomedical Engineering, University of Michigan; and the Departments of Surgery and Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine.

Received for publication July 10, 2018; accepted November 16, 2018.

Dr. Kubiak and Dr. Etra contributed equally to this work.

Dr. Lee and Dr. Cederna contributed equally to this work.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Paul S. Cederna, M.D., Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-5456,, Instagram: @paulcederna

Copyright © 2019 by the American Society of Plastic Surgeons