title: Assessment and Planning for a Pediatric Bilateral Hand Transplant Using 3-Dimensional Modeling: Case Report.
abstract: Children are not typically considered for hand transplantation for various reasons, including the difficulty of finding an appropriate donor. Matching donor-recipient hands and forearms based on size is critically important. If the donor's hands are too large, the recipient may not be able to move the fingers effectively. Conversely, if the donor's hands are too small, the appearance may not be appropriate. We present an 8-year-old child evaluated for a bilateral hand transplant following bilateral amputation. The recipient forearms and model hands were modeled from computed tomography imaging studies and replicated as anatomic models with a 3-dimensional printer. We modified the scale of the printed hand to produce 3 proportions, 80%, 100% and 120%. The transplant team used the anatomical models during evaluation of a donor for appropriate match based on size. The donor's hand size matched the 100%-scale anatomical model hand and the transplant team was activated. In addition to assisting in appropriate donor selection by the transplant team, the 100%-scale anatomical model hand was used to create molds for prosthetic hands for the donor.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: galvezj@email.chop.edu.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Gálvez
authors.affiliation: Department of Cardiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Gralewski
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
authors.forename: Christine
authors.initials: C
authors.lastname: McAndrew
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Rehman
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA; Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Chang
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
mesh_terms: D000671:Amputation, Surgical; D002648:Child; D063987:Hand Transplantation; D006801:Humans; D008297:Male; D008953:Models, Anatomic; D066330:Printing, Three-Dimensional; D018805:Sepsis / Q000150:complications; D012984:Software
keywords: Donor selection; hand transplantation; pediatrics; three-dimensional printing; vascularized composite allotransplantation