[Ten years of hand transplantation experiment or routine?].

In the 20th century the legend of Cosmas and Damian - an extremity being transferred from one person to another - became reality. The first hand transplantation was carried out in 1964 in Ecuador but the hand had to be removed again within three weeks due to rejection. Although he was the first one to be treated with more modern immunosuppressants, the same fate overtook another patient who received a hand from a brain-dead donor in 1998 in Lyon. Since then only 32 persons worldwide have been provided with parts of the upper extremity. The partly published histories of three patients who have had both hands transplanted will be summarised and indication critically assessed once again. It is also stressed how difficult, multi-layered and complex the patient's education is. The patient has to be informed in many conversations beforehand about every stage of therapy but also about possible complications and even rejection. Can the psychological burden/stress while waiting for a donor, the difficult post-operative period, lifelong adherence to a rigorous drug-regimen, the complexity of the whole procedure be made comprehensible to a layman? To replace same with same is the goal of the best-possible reconstructive surgery. It is to hope that through future innovations in the immunosuppressing therapy patients can be offered transplantation of one or both hands as a routine-operation. Until then indication has to be strict and the operation can possibly only be performed in a few centres. Long-time prospects, disadvantages and complications, as well as side effects have to be presented openly. Georg Thieme Verlag KG Stuttgart * New York.