One hundred medical students completed a time trade-off survey to assess the utilities of single and double hand transplantation and the use of hand prostheses. The aim of this study was to assess the utility and estimate the costs of hand transplantation and the use of hand prostheses for forearm amputations. Hand transplantation has received international attention in recent years however, the economic impact of this innovative treatment is uncertain.
1), it appears to be equivalent to a developing limb bud in the embryo, both at the molecular and functional levels. The first is that, since development and regeneration to a large degree utilize the same mechanisms3,4, it follows that humans therefore possess the genetic pathways (genes) that will be required for regenerating a limb because these are the same genes that were used when human adults were embryos5. There are three important conclusions that can be drawn on the basis of the conservation of developmental and regenerative mechanisms among tetrapods (the group of vertebrates with four feet or legs or similar appendages, including amphibians, reptiles, birds, and mammals). Similarly, the mechanisms regulating limb regeneration are largely the same as those regulating limb development3,4, and thus evolution appears to have selected for a conserved set of signaling pathways that regulate both vertebrate limb development and regeneration. The fact that this remarkable degree of conservation has been maintained over the course of evolution implies that the mechanisms for appendage development have evolved once. The molecules involved in the signaling pathways that regulate limb development are not only conserved at the level of nucleotides and/or amino acids but also at the functional level, so that experimentally substituting homologous genes between species as divergent as humans and Drosophila can rescue the function of a mutant gene2. This conservation of developmental mechanisms is one of the fundamental discoveries of molecular genetics and is the basis for our emerging understanding of the evolution of animal genomes. Vertebrate appendages such as limbs and fins share evolutionarily conserved mechanisms for development and regeneration, implying that they evolved from an appendage that arose on a common ancestor1. HAT recipients showed notable functional gains, but most complications resulted from the IS protocols. Fifty-two complications caused by IS agents were reported, and they were successfully managed medically or surgically. Three grafts were lost to follow-up because of noncompliance with immunosuppression, rejection, and arterial thrombosis, respectively. Duration of ischemia, extent of transplantation, and time since amputation were not associated statistically with the return of intrinsic musculature function. The presence of intrinsic muscle function was observed in 57% of the recipients. Lower DASH scores (P = 0.036) were recorded after secondary surgery on hand allografts. Among these patients, disabilities of the upper limb dropped by a mean of 27.6 (☑9.04) points on the DASH score after HAT (P = 0.005). Twenty-eight patients were reported in 56 clinical manuscripts.
Infectious, metabolic, and oncological complications because of IS therapy were recorded. Duration of ischemia, extent of amputation, and time since amputation were evaluated for their effect on intrinsic musculature function. Clinical cases of HAT published between 19 in English, French, or German were reviewed systematically, with emphasis on comparing disabilities of the arm, shoulder and hand (DASH) scores before and after transplantation. The aim of this work is to compare disabilities of the upper limb before and after hand allograft transplantation (HAT), and to describe the side effects of immunosuppressive (IS) agents given to recipients of hand allografts.
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