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Functional Comparison of Hand Transplantation and Prosthetic Fitting in Below-Elbow Amputees
Stefan Salminger, MD1; Agnes Sturma, BSc1; Aidan Roche, MD, PhD1; Marina Ninkovic, MD, PhD2; Gerhard Pierer, MD, PhD3; Adam Chelmonski, Md, PhD4; Jerzy Jablecki, MD, PhD4; Oskar C. Aszmann, MD1
1Division of Plastic and Reconstructive Surgery, Medical University of Vienna, CD Laboratory for Restoration of Extremity Function, Vienna, Austria; 2Department of Physical Medicine and Rehabilitation, Medical University of Innsbruck, Innsbruck, Austria; 3Department of Plastic and Reconstructive Surgery, Medical University of Innsbruck, Innsbruck, Austria; 4Subdepartment of Replantation of Limbs, Hand Trauma Center St. Hedwigs's Hospital, Trzebnica, Poland

Background: Composite tissue transplantation and improvements in the field of prosthetics have opened new possibilities in restoring hand function in upper limb amputees. These two concepts aim at restoring solid hand function, however, the indications, advantages and limitations for each treatment must be carefully considered depending on level and extent of amputation. Here we report our findings of a multi-center study comparing hand function in a cohort of transplanted and prosthetic hands.

Material and Methods: Seven male unilateral below elbow amputees fitted with prosthetic limbs and five male transplanted patients from Austria and Poland, 2 of them bilateral and 3 unilateral were tested. Hand function of all patients was tested with the Action Research Arm Test (ARAT), the Southampton Hand Assessment Procedure (SHAP) and the Disabilities of the Arm, Shoulder and Hand measure (DASH) and the results of both groups compared. In addition, in unilateral amputees, function was compared with that of the contralateral remaining limb.

Results: The transplanted patients achieved a mean ARAT score of 40.86 8.07 out of 57 and an average SHAP score of 75 11.06 points. In comparison, prosthetic patients achieved a mean ARAT score of 39 3.61 out of 57 and an average SHAP score of 75.43 10.81 points. No significant difference between transplanted and prosthetic hands in ARAT and SHAP could be identified. In unilateral patients, the transplanted hands could achieve 74.59 17.09 % in SHAP and 70.76 8.29 % in ARAT in relation to their healthy hand, the prosthetic patients 77.17 10.9 % in SHAP and 68.42 6.32 % in ARAT respectively.

Conclusions: Bilateral transplantation patients are forced users and definitely benefit from being totally independent in daily living. However, even though unilateral prosthetic users only gain a helping hand, the results of both groups show similar outcomes in hand function. Hand transplantation and prosthetic reconstruction are complementary and not competitive methods for functional reconstruction in transradial amputees, however the indication must be carefully weighed for each patient. Due to the significant side effects of immunosuppression the indication for allotransplantation must still be restrictive, the best being bilateral amputees. Considering the high quality of prosthetic hand function we therefore believe that unilateral amputees should be treated with prosthetic means.

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