A Milestone for Hand Surgery

In early July, the field of hand surgery reached another milestone: the first pediatric bilateral hand transplant.  

Eight-year-old Zion Harvey lost his hands and feet due to sepsis when he was a toddler.  By age 4, he needed and received a kidney transplant and was placed on an immunosuppressive regimen; this regimen made him the perfect candidate to attempt a transplant since doctors could piggyback off his current medication.  ASSH member L. Scott Levin, MD, FACS, who established the Penn Hand Transplant program, led the transplant team of 40 staff members.  The team broke into four groups and after 10 hours successfully completed Zion’s bilateral hand transplant.  “My colleagues who participate in the microvascular aspects of the care are just the best in the world,” said Levin.  ASSH members who were on the team include:

  • David J. Bozentka, MD

  • Robert B. Carrigan, MD

  • Benjamin Chang, MD 

  • Scott H. Kozin, MD

  • Ines Lin, MD

  • David R. Steinberg, MD 

  • Dan A. Zlotolow, MD

Staff hailed from Penn Medicine/The Children’s Hospital of Philadelphia, where the procedure was performed, and from Shriners Hospitals for Children, where Zion was originally seen.  “The collaborative effort between these institutions was necessary to assemble the team and organize the players to orchestrate such a complex and demanding procedure that had never been performed on a child,” explained Scott H. Kozin, MD, chief of staff for Shriners Hospitals for Children, to Medical News Today.

Hand transplants rely on three main determinants: the size of the hands, the color match and the blood type.  “We want to really make sure that this was going to work for our patient and work for a lifetime, not just a year.  For us this is not just a technical exercise, it’s really trying to restore a better level of lifetime function for these patients,” explained Benjamin Chang, MD.  Taking their experiences from performing replantations following amputations (e.g., Levin led the team that did Penn’s first bilateral transplant on an adult in 2011), Zion’s team firmly believes that his hands will grow normally, and they are prepared if any sign of rejection occurs.

As the field of vascularized composite allotransplantation evolves, this bilateral pediatric hand transplantation can give hope to other children with similar hand problems, both those who had accidents that resulted in amputation as well as those with congenital absence of limbs.  Dr. Levin explained to Medscape, “There is promise and hope, now that we’ve demonstrated that this can be done in a child.  The pediatric world will hopefully embrace this, and we’ll figure out ways to go forward ethically and carefully to make this a reality and to give other children with limb loss their hands and quality of life back.”

Weeks after his surgery, Zion continues to receive hand therapy, and he is already using his own muscles to power the tendons in his new hands to pick up small objects.  This shows promise that he will regain sensation and feeling in these hands… and perhaps one day swing on the monkey bars, as he wants to do.

The ASSH celebrates this monumental accomplishment in the field of hand surgery.  The dedication and passion that our members bring to the field and the improved quality of life that they bring to their patients is the reason we all chose this career, and this great milestone is a tribute not only to where we’ve been, but also where we are going. 

© 2015 American Society for Surgery of the Hand