Surgeons at The Children’s Hospital of Philadelphia (CHOP) joined along with colleagues from Penn Medicine recently to finish the world’s very first bilateral hand transplant on a child. Earlier this month, the surgical group successfully transplanted donor hands and forearms onto eight-year-old Zion Harvey who, several years earlier, had undergone amputation of his hands and feet and a kidney transplant adhering to a serious infection.
Led by L. Scott Levin, M.D., FACS*, Chairman of the Department of Orthopaedic Surgery at Penn Medicine, Director of the Hand Transplantation Program at The Children’s Hospital of Philadelphia, and Professor of Surgery (Division of Plastic Surgery) at the Perelman School of Medicine at The University of Pennsylvania, a 40-member multidisciplinary group of physicians, nurses and various other staff from plastic and reconstructive surgery, orthopaedic surgery, anesthesiology, and radiology, participated in the operation. Attending surgeons from CHOP and from Penn Medicine, along along with Scott H. Kozin, M.D.***, chief of staff for Shriners Hospitals for Children–Philadelphia, collaborated throughout the 10-hour surgical transplantation.
“This surgery was the result of years of training, followed by months of preparing and preparation by a remarkable team,” said Levin. “The victory of Penn’s very first bilateral hand transplant on an adult, performed in 2011, gave us a foundation to adapt the intricate techniques and coordinated plans called for to perform this sort of complex procedure on a child. CHOP is one of the few places worldwide that offer the capabilities vital to push the limits of medicine to provide a Youngster a drastically improved quality of life.”
“This extraordinary accomplishment highlights the world-class abilities of the physicians, nurses, therapists and various other staff that are privileged to serve our patients and their families along with ability and dedication,” said Madeline Bell, president and chief executive officer of The Children’s Hospital of Philadelphia. “I’m especially grateful to Zion’s family that entrusted him or her to our care.”
“The ability to strategy and carry out this sort of surgery is testament to the skill, expertise, surgical innovation, and passion for excellence available here at The Children’s Hospital of Philadelphia,” said N. Scott Adzick, M.D., CHOP’s surgeon-in-chief. “I am very proud of Dr. Levin and his group for their courage, dedication and expertise, and appreciative to Zion and his family, whose bravery and trust in this clinical group is actually inspiring.”
Zion was initially referred to Shriners Hospitals for Youngsters for their expertise in pediatric orthopaedic care, including surgery and rehabilitation. Through a coordinated effort between Shriners Hospitals for Youngsters and CHOP, Zion was evaluated as a feasible recipient of the very first pediatric hand transplant. “The collaborative effort between these institutions was vital to assemble the group and organize the gamers to orchestrate such a complex and demanding procedure that had never been performed on a child.” explained Scott H. Kozin, M.D., chief of staff for Shriners Hospitals for Children–Philadelphia.
Before the surgery could be conducted, it was very first vital to locate a suitable donor, a function coordinated by Gift of Life Donor Program, the nonprofit organ and tissue donor program which serves the eastern half of Pennsylvania, southern Brand-new Jersey and Delaware. “For 41 years, Gift of Life Donor Program has actually partnered along with transplant centers throughout this region to bring innovative transplant procedures to patients in need,” explained Richard Hasz, vice president of Clinical Services for Gift of Life. “As along with all types of transplant, surgeries such as this one could not take place free of the generosity of a donor and a donor family. We thank them for their selflessness and for their gift that Gained this surgery possible.”
“The skills vital to perform such complex surgery at CHOP have actually been acquired from lessons learned over the past 20-plus years of performing pediatric tough organ transplantation,” said Abraham Shaked, M.D., Ph.D., the Eldridge L. Eliason Professor of Surgery and Director, Penn Transplant Institute. “We have actually learned the importance of closely monitoring and managing the activity of the immune system through years of experience, and are hopeful that Zion will certainly take pleasure in fantastic long-term allograft function and a normal life.”
Zion Harvey is a bright and precocious eight-year-old that has actually told his doctors that he cannot wait to someday throw a football. A happy and outgoing child, he has actually adapted well to life free of hands, learning to eat, write and even play video games. He figured out methods to perform most of the activities various other children his age can easily do. Zion received prosthetics for his feet and is able to walk, run and jump along with finish independence. adhering to his latest surgery and after his upcoming rehabilitation, it is expected that Zion will certainly finally get hold of his wish to throw a football along along with a myriad of various other accomplishments to come.
Double hand transplantation is a complex procedure involving numerous surgical and non-surgical components. First, the potential recipient should undergo extensive medical screenings and evaluations Prior to surgery. In this case, the patient’s previous medical condition, adhering to sepsis at an early age, factored in to the decision to perform the transplant. “Zion’s kidney transplant adhering to his infection Gained him or her a candidate for transplant due to the fact that he was already taking anti-rejection medication,” said Benjamin Chang, M.D.**, co-director of CHOP’s Hand Transplant Program as well as associate chief of the Division of Plastic Surgery at Penn Medicine.
During the surgery, the hands and forearms from the donor were attached by connecting bone, blood vessels, nerves, muscles, tendons and skin. The surgical group was divided in to four simultaneous operating teams, two focused on the donor limbs, and two focused on the recipient. First, the forearm bones, the radius and ulna, were connected along with steel plates and screws. Next, microvascular surgical techniques were used to connect the arteries and veins. Once blood flow was established through the reconnected blood vessels, surgeons individually repaired and rejoined each muscle and tendon. Surgeons after that reattached nerves then closed the surgical sites.
Zion continues to receive day-to-day immunosuppressant medications to steer clear of his physique from rejecting the Brand-new limbs, as well as his transplanted kidney. Zion is being cared for by CHOP’s nephrology and kidney transplant team, as well as his hand transplant surgical team. Short article surgery, he spent a week in CHOP’s Pediatric Intensive Care Unit, after that was moved to a medical unit and eventually moved to an inpatient rehabilitation unit where he undergoes rigorous hand therapy several times per day, an necessary step to gaining improvement in function.
The clinical group expects Zion to spend several a lot more weeks in CHOP’s rehabilitation unit, then to be discharged to his estate in Baltimore, Md. Dr. Levin and his group will certainly keep on to follow Zion monthly in the short-term then annually throughout his lifetime.
* L. Scott Levin, M.D., FACS, holds several medical posts. He is Director of the Hand Transplantation Program at The Children’s Hospital of Philadelphia; Chairman of the Department of Orthopaedic Surgery at Penn Medicine; The Paul B. Magnuson Professor of Bone and Joint Surgery at Penn; and Professor of Surgery (Division of Plastic Surgery) at the Perelman School of Medicine at The University of Pennsylvania.
**Dr. Benjamin Chang, M.D., is co-director of CHOP’s Hand Transplantation Program; associate chief of the Division of Plastic Surgery at Penn Medicine; and associate professor of Clinical Surgery at the Perelman School of Medicine at The University of Pennsylvania.
***Scott H. Kozin, M.D., is chief of staff for Shriners Hospitals for Youngsters and clinical professor of the Department of Orthopaedic Surgery at Temple University School of Medicine.