From the Department of Surgery, Section of Plastic and Reconstructive Surgery, and the Department of Biomedical Engineering, University of Michigan; and the Departments of Surgery and Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine.
Plast Reconstr Surg. 2019 Jun;143(6):1688-1701. doi: 10.1097/PRS.0000000000005638.
Upper limb loss is a devastating condition with dramatic physical, psychological, financial, and social consequences. Improvements in the fields of prosthetics and vascularized composite allotransplantation have opened exciting new frontiers for treatment and rehabilitation following upper limb loss. Each modality offers a unique set of advantages and limitations with regard to the restoration of hand function following amputation.
Presented in this article is a discussion outlining the complex considerations and decisions encountered when determining patient appropriateness for either prosthetic rehabilitation or vascularized composite allotransplantation following upper limb loss. In this review, the authors examine how psychosocial factors, nature of injury, rehabilitation course, functional outcomes, and risks and benefits may affect overall patient selection for either rehabilitative approach.
This review summarizes the current state of the literature. Advancements in both prosthetic and biological strategies demonstrate promise with regard to facilitating rehabilitation following upper limb loss. However, there remains a dearth of research directly comparing outcomes in prosthetic rehabilitation to that following upper extremity transplantation.
Few studies have performed a direct comparison between patients undergoing vascularized composite allotransplantation and those undergoing prosthetic rehabilitation. Upper extremity transplantation and prosthetic reconstruction should not be viewed as competing options, but rather as two treatment modalities with different risk-to-benefit profiles and indications.
上肢缺失是一种毁灭性的疾病，会带来巨大的身体、心理、经济和社会后果。假肢和血管化复合组织同种异体移植领域的进步为上肢缺失后的治疗和康复开辟了令人兴奋的新前沿。每种治疗方法在手功能恢复方面都有独特的优势和局限性。
本文讨论了在确定上肢缺失后患者适合假肢康复还是血管化复合组织同种异体移植时所遇到的复杂考虑因素和决策。在这篇综述中，作者检查了心理社会因素、损伤性质、康复过程、功能结果以及风险和益处如何影响两种康复方法的总体患者选择。
本文总结了目前的文献状况。假肢和生物策略的进步都在手部缺失后的康复方面显示出了希望。然而，直接比较假肢康复和上肢移植的结果的研究仍然很少。
很少有研究对接受血管化复合组织同种异体移植和接受假肢康复的患者进行直接比较。上肢移植和假肢重建不应被视为相互竞争的选择，而应被视为两种具有不同风险-效益特征和适应证的治疗方式。
