Reconstruction for All: The Case for Pediatric Hand Transplantation

The advent of vascularized composite allotransplantation (VCA) has ushered in a new era of reconstructive surgery. Lower rungs on the reconstructive ladder rely on autologous tissue, alloplastic materials and pretreated biologics to reconstruct and mimic the functional and aesthetic components of human anatomy. VCA, however, uniquely provides the exact functional components in the appropriate anatomic configuration to restore both form and function together in a single unit. Following the first successful hand transplant in 1998, the medical community has progressively adopted VCA as a viable restorative option for a multitude of functional defects. Reconstructive Hand Transplantation (RHT) remains the most commonly practiced form of VCA and to date, 72 patients in 16 countries have undergone transplantation of 107 upper extremities over the past 17 y. As this field continues to gain traction and enjoy advances in transplant medicine, it is time we consider pediatric recipients who may have more to gain from our efforts. Noncompliance with immunosuppression and hand therapy may impede outcomes; yet, with proper patient selection and adequate familial and social support we can restore a sense of wholeness and normalcy to our children who have suffered limb loss.