[Hand allograft in agenesic newborn: feasibility study].
Would a newborn with a single hand benefit from hand allograft? Transantebrachial aplasia is the chosen clinical form of agenesia in our interrogation. The feasibility study presents several aspects: 1) ethical and psychological aspects. Is this a desired surgery for agenesic population? Which are the functional, psychological and social situations of agenesic patient? Is the hand transplantation in newborn ethically acceptable? What is the parents' attitude toward agenesia? Can we envisage organ donation in neonatal period? 2) immunological aspects. The non-vital character of this condition and its' good functional tolerance cannot make accepting the risk of adverse effects of hand allotransplantation. Hence, one may consider this surgery only without immunosuppression. Can the peculiarities of the neonate "immature" immune system represent an opportunity of easier tolerance obtaining, avoiding immunosuppression? 3) anatomical and technical aspects. The proximal tissues at the level of amputation are all hypoplastic in agenesic patients. Can we efficaciously suture those structures with donor eutrophic tissues? 4) cognitive aspects. Is a neonate born with only one hand is able to use two? A feasibility study on such a subject needs to take into account all these aspects. This research is useful because, even if hand allograft in agenesic newborn will never be done, the provided information will allow to progress in the vaster domain of composite tissue allotransplantation in perinatology.
Gazarian
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Chirurgie de la main et du membre supérieur, clinique du Parc, hôpital Debrousse, pavillons Tbis (orthopédie pédiatrique) et V (transplantation), hôpital Edouard-Herriot, 86, boulevard des Belges, 69006 Lyon, France. a.gazarian@cliniqueduparcklyon.com
Abrahamyan
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D005240:Feasibility Studies; D006226:Hand Deformities / Q000601:surgery*; D063987:Hand Transplantation; D006801:Humans; D007231:Infant, Newborn; D008866:Microsurgery / Q000379:methods