Originally created 01/26/99

Doctors perform hand transplant



LOUISVILLE, Ky. -- A man who lost his left hand in a firecracker explosion 13 years ago received a new one transplanted from a cadaver, and doctors saw the hand turn pink and show signs of life.

The 14 1/2 -hour surgery, completed Monday morning, was the second such transplant ever and the first in the United States.

But doctors cautioned that the patient, Matthew David Scott, had a high risk of blood clots and other complications in the first 24 hours.

There is as much as a 50 percent chance the hand will be rejected in the next year, forcing Mr. Scott to take powerful anti-rejection drugs that suppress the immune system and increase the risk of infection, cancer and death. Scar tissue could develop, snagging the spliced tendons.

"The real battle and unknown starts now," said Dr. Warren C. Breidenbach, who led the surgical team at Jewish Hospital.

Dr. Breidenbach said first signs were good for Mr. Scott, 37. The "hookup" of veins and arteries had worked, providing blood for the hand to turn pink.

Mr. Scott, a paramedic, lost his dominant hand in a Dec. 23, 1985, blast from an M-80, which resembles a firecracker but is far more powerful. M-80s have been illegal in the United States since 1966.

Mr. Scott has worn a prosthetic device ever since. He was able to resume working, and in 1990, was named National Paramedic of the Year by Emergency Medical Services magazine, said Tom Starr, director of the Mobile Intensive Care Unit at Virtua Health, where Mr. Scott now oversees paramedic training.

Some doctors have questioned the risks of transplanting a nonvital organ such as a hand. But Dr. Breidenbach said Mr. Scott was chosen for the experimental transplant because he had not adapted well to his artificial hand and is intelligent, articulate and has plenty of support from his family, which includes a wife and two sons.

"I'm sure he understands very well what the risks are. There's no doubt in my mind he did think things through very carefully," said Regina Twisdale, who has known Mr. Scott about 15 years. She is director of the School of Paramedic Science at Camden County College, where Mr. Scott is assistant director.

Even so, Mr. Scott can only hope to gain limited use of the hand -- able to pick up objects but unable to button his shirt, Dr. Breidenbach said.

"You should be able to get fairly good flexation and extension -- not complete -- and some sensation, but not normal," Dr. Breidenbach said.

The only other hand transplant was performed in Lyon, France, in September on Clint Hallam, a New Zealand man who lost part of his right arm in a prison sawing accident in 1984.

Dr. Jon William Jones Jr., an organ rejection expert who assisted Dr. Breidenbach, said Mr. Hallam has shown no sign of rejecting his donor hand and has passed the period in which 90 percent of rejections occur.

Mr. Scott's operation began at 3:30 p.m. Sunday and was completed about 6 a.m. Monday. The hospital refused to disclose any information about the donor.

The surgery required joining the cadaver hand a bit above wristwatch level with Mr. Scott's arm.

The surgeons had to join the bones, clamping them together with metal plates and screws. Tendons were attached and gently tugged to make sure they would cause fingers to move.

Nerves were joined next, then arteries and veins.

Surgeons for years have been able to reattach severed limbs following accidents, but they had never been able to successfully transfer a limb from a dead donor to a living recipient.

At least one attempt at a hand transplant occurred in South America in 1964, but the patient's body rejected the hand within two weeks.