Secondary surgery for functional improvement after hand transplantation.

Unilateral and bilateral hand transplantations have been performed worldwide with good midterm functional results. The role of secondary surgery to improve function in the patients with hand transplant has not been uniformly agreed upon. A series of 10 secondary procedures were performed in 5 surgeries on 3 patients with bilateral upper extremity transplantation. There was 1 incidence of acute rejection after 1 procedure. The functional improvement was evaluated subjectively by the patients as substantial. Secondary procedures can upgrade function after hand transplantation and provide unique opportunities for deep-tissue biopsies. The proinflammatory stimulus of the surgery can theoretically precipitate an acute rejection. The pharmacologic interference of some immunosuppressive drugs with wound healing should also be considered.