3D Printed Models Helped Surgeons Prepare for World’s First Pediatric Bilateral Hand Transplant

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As many 8-year-old boys do, Zion Harvey wanted to swing on the monkey bars and to pick up his little sister and swing her around as they played. Zion, however, is unlike many other children his age, demonstrating not only life experience but a resilience and wisdom beyond his years; when he was only two years old, Zion got sick. Very sick.

zion before surgeryA bacterial infection in 2008 threatened his life, resulting in multiple organ failure. As a toddler, Zion lost his hands and his legs below the knee to the disease, which had also shut down his kidney function, leaving him reliant on dialysis for two years. While many mothers say they would give anything for their children, Zion’s mom, Pattie Ray, gave her son a kidney. The transplant meant the youngster would be on anti-rejection medications for the rest of his life.

zion and dr photo CHOPIn the years since his illness, Zion has rebounded as an energetic and intelligent elementary school kid, bounding down the hallways on his prosthetic legs and using a smartphone with his handless arms. When he and his mom went to Shriners Hospitals for Children – Philadelphia in 2012, they intended to discuss upper limb prosthetics for Zion–but Dr. Scott Kozin and Dr. Dan Zlotolow had something bigger in mind. The doctors referred Zion to Dr. L. Scott Levin, chairman of the department of orthopedic surgery at Penn Medicine and director of the Hand Transplantation Program at Children’s Hospital of Philadelphia (CHOP), struck by inspiration to go beyond prosthetics for Zion.

“The success of Penn’s first bilateral hand transplant on an adult, performed in 2011, gave us a foundation to adapt the intricate techniques and coordinated plans required to perform this type of complex procedure on a child,” Dr. Levin said in a statement.

The world had never before seen a double hand transplant on a pediatric patient, so the idea wasn’t just big–it was groundbreaking. And it needed a lot of preparation.

zion orZion was observed for 18 months to establish his place as a candidate for the procedure; in what might seem a strange twist, his kidney transplant years before made him a more viable candidate, as the new transplant would require lifelong drug therapy, which doctors can be hesitant to begin for pediatric patients. Because Zion was already taking the drugs, he was a strong contender for new donor hands.

“I hoped for somebody to ask me do I want a hand transplant and it came true,” Zion told NBC News.

Candidacy and will established, the 40-strong team of doctors and nurses started their own prep work.

zion and momThe doctors readied themselves, with surgeons rehearsing several times using cadavers to prepare for the incredibly intense procedure; the OR team would function in four teams, working at the same time, with two teams dedicated to the donor limbs and two to the recipient. Bones, blood vessels, muscles, and tendons would all need to come together in microsurgery to ensure full function.

“There’s a saying in surgery,” says Dr. Levin. “’The only shortcut is preparation.’”

And, of course, the hands had to fit. Based on Zion’s needs, doctors estimated that only about 15 donors per year might meet his age, gender, skin color, and size needs.

To ensure the donor hands would work for a young and growing child, the medical team took detailed CT scans of Zion’s forearms. Dr. Levin and another team member used the scans to create 3D printed sample hands. These replicas were made to exactly fit Zion, as well as in sizes 20% larger and 20% smaller–somewhere in this range would fit Zion. These precisely measured 3D printed hand models allowed the doctors to identify potential donor limbs as viable for transplant.

When the doctors received word from the Gift of Life Donor Program that a suitable donor had been found, Dr. Levin took the 3D printed hands with him to compare the sizes and check potential fit.

Only three months after agreeing to the procedure, Pattie Ray received a call: doctors had hands for Zion, get to the hospital now.

Following a 10.5-hour operation, unprecedented in execution but well-rehearsed, Dr. Levin saw Zion’s blood flowing successfully through his new hands. Just two days later, the boy was able to grasp small objects in his fingers. Zion is receiving daily occupational therapy as he gains functionality in the hands, and will continue to be monitored for any signs of potential rejection–but for now, it looks like the world’s first pediatric bilateral hand transplant was a resounding success.zion after surgery photo CHOP

Tell us your thoughts on this incredible operation in the Double Hand Transplant forum thread over at 3DPB.com. You can read more about Zion’s story from CHOP; be sure to grab tissues before watching the video below detailing the boy’s journey.

[Photos: CHOP]

 

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