Clinic of High Medical Technologies named after N.I. Pirogov, St. Petersburg State University

History

2023: Successful finger-to-hand transplant of a child from his mother's leg

On December 12, 2023, specialists from the N. I. Pirogov High Medical Technology Clinic of St. Petersburg State University (St. Petersburg State University) announced a unique operation to transplant a donor finger to an eleven-year-old child with leukemia. This procedure will allow the boy to restore the brush function.

In the first years of his life, a small patient was diagnosed with acute lymphoblastic leukemia. At the age of three, the boy received a bone marrow transplant from his mother, but this caused a graft-versus-host reaction: the transplanted bone marrow and its immune system began to attack the cells of the recipient's body. This process took on a chronic form, causing the death of areas of the skin and affecting the joints, mucous membranes, eyes and organs of the gastrointestinal tract.

A unique operation was performed to transplant a donor finger to an eleven-year-old child with leukemia

The boy was given combined massive immunosuppressive therapy. Doctors managed to achieve remission of cancer and stop the rejection reaction, but this provoked secondary immunodeficiency. The child's skin was scarred, he had no hair and eyelashes left, and his fingers fused together and were in a bent and sedentary state. To restore the functionality of the hands, the team of surgeons of the St. Petersburg State University clinic conducted two autodermoplastics, thanks to which it was possible to separate the fingers, achieve the correct position of the thumb and return the mobility of the hands. However, the patient's weakened immune system could not cope with another infection - and the boy developed necrosis of the thumb against the background of sepsis.

To save the brush and return its functionality to the child, doctors performed the most difficult two-stage operation. On the first, they removed the dead tissues of the thumb and transplanted a piece of mom's skin. Because after a transplant, her immune system and her son's immune system are copies, the chances of rejection are greatly reduced. At the second stage, it was necessary to restore the thumb, which, after complications, lost the ability to bend and did not reach the other fingers. Most often, in such cases, a finger is transplanted from the patient's foot to his hand. However, due to the consequences of secondary scleroderma, which affected the fingers of the child's foot, this option of treatment was impossible.

Therefore, for the first time in Russia, doctors transplanted part of the second finger from his mother's foot to the boy. Microsurgical technologies made it possible to sew thin vessels and nerves under a microscope, which allowed the finger to fully take root. And after the bone grew together, the patient was sent for further rehabilitation.^[1]

Notes