Hand Transplant Patient Doing Well
Jan. 26, 1999
LOUISVILLE, Ky. (AP) _ Thirteen years after an explosive blew off his left hand, Matthew David Scott has a new one.
``He stares at it and grins,'' family friend James Brown said Monday as Scott, a paramedic from Absecon, N.J., recovered from the first hand transplant in the United States.
The 14 1/2-hour surgery ended early Monday at Jewish Hospital in Louisville. His doctors said Scott, 37, was doing as well as possible. They watched closely for blood clots, other complications and any sign that the donor hand was being rejected.
``We don't expect to see rejection in the early phase. Our big concern is in the first three months,'' said Dr. Jon William Jones Jr., an organ rejection expert who was part of the surgical team.
A hospital spokeswoman said today there were no blood clots or other complications overnight.
``He is doing very well,'' Kim Freeman said. ``He's alert. Everything is progressing as expected.''
Tiny pieces of skin from the hand will be microscopically examined every few days to see if lymphocytes _ tissue-killing cells _ are attacking it, Jones said. If so, Scott's medication could be adjusted.
Scott was being given powerful drugs that reduce the chances of rejection but pose significant dangers of their own. His suppressed immune system makes him vulnerable to infections that could be life threatening, said Jones and the lead surgeon, Dr. Warren Breidenbach.
Scott 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.
In an interview with The Courier-Journal before the surgery, Scott said the accident that cost him his hand came at a friend's house after a night of partying.
``I was 24,'' Scott said. ``It was Christmas. We were ... out at a club, laughing it up, having a good time.''
The firecracker was sitting out in the open. Scott said he ``very foolishly'' picked it up, and, ``with a young man's bravado,'' touched his cigarette to the wick.
The blast from the M-80 tore most of his hand off, leaving parts of two fingers but little else. What remained was amputated above the wrist.
Scott got a prosthetic hand and resumed working. In 1990, he 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
Scott now oversees paramedic training in southern New Jersey. He also is assistant director of the School of Paramedic Science at Camden County College.
Some doctors have questioned the risks of transplanting a nonvital organ such as a hand. Breidenbach said Scott was chosen because he had not adapted well to his artificial hand and is intelligent, articulate and has support from his family, which includes his wife and two young sons.
Scott learned about the Louisville doctors' plans to attempt a hand transplant last summer, when his wife read a newspaper article while they were vacationing in London. He called the hospital hours after returning home.
In an interview before his surgery, Scott said that with his artificial hand he lived in fear of going through buffet lines and handling food at parties. Nor was he able to show his sons how to play baseball, he said.
``It's always been the little things _ the daily little things,'' Scott said.
Even so, Scott can only hope to gain limited use of the transplanted hand _ able to pick up objects but unable to button his shirt, Breidenbach said.
``You should be able to get fairly good flexation and extension _ not complete _ and some sensation, but not normal,'' Breidenbach said.
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.
In September, a hand transplant was performed in Lyon, France, on a New Zealand man who lost part of his right arm in a prison sawing accident in 1984. 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.
The recent surgery joined the cadaver hand a bit above wristwatch level with 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. The hospital refused to disclose any information about the donor.