Hand transplantation

Historical remarks: Cosma and Damian revisited.- Experimental limb transplantation: Rodents. Primates.- Organization of a hand transplantation program: Selection of the candidates and waiting list. Dealing with the media and the public. Setting up a pilot study and clinical trial. Organization and staff requisites for hand transplantation.- Ethics of non life-saving transplantation.- Immunology of hand transplantation: Skin antigenicity. Composite tissue and antigenic response.- Surgical technique of hand transplantation: The donor. The recipient. Differences between hand replantation and transplantation.- Immunosuppressive therapy: Induction and maintenance therapy. Side-effects. CMV infection and reactivation. Complications.- Functional recovery of transplanted hands: Rehabilitation and physiotherapy. Return of sensibility. Motor recovery - extrinsic and intrinsic muscles. Analysis of movement. The virtual glove and computer assisted assessment of results. Brain remodelling and plasticity of hand cortical representation. Functional magnetic resonance imaging. The sensory glove in preoperative conditioning and postoperative rehabilitation. Quality of life and hand transplantation.- Medico-legal implications: Informed consent. Insurances. Privacy issues in hand transplantation. Fingerprints.- Dermatologic analysis of the transplanted skin.- Limb rejection and monitoring: Histological evaluation and grading system. Acute and chronic rejection. Pharmacological treatment of rejection. Psychological issues in hand transplantation: Psychological profile of the patients. Body image and hand transplantation.- Tolerance and chimerism in hand transplantation.- Other composite tissue transplants: Knee transplantation. Larinx transplantation. Uterus transplantation.- Future directions: Face transplantation. Limb transplantation in congenital deformities. The International Registry of Hand and Composite Tissues Transplantation.- The complete bibliography on hand transplantation.- Images and video-clips of hand transplantation (DVD).