[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-434376-105":59,"doc-detail-434376-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","restitution-or-substitution-after-loss-of-a-human-hand-a-personal-view","Restitution or substitution after loss of a human hand - A personal view","","The author provides a personal perspective on managing upper-limb loss, contrasting prosthetic care with allotransplantation. He traces how a Leeds hand-transplant service was developed from early uncertainty toward a prospective, protocol-driven cohort. Key experiences include early success, later complications, and reflective surgical lessons. The article also explains why replacement becomes a central “third R” and discusses prosthesis evolution, including cable-driven and powered options, and ongoing challenges like bandwidth for brain-device control.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/restitution-or-substitution-after-loss-of-a-human-hand-a-personal-view/434376/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/restitution-or-substitution-after-loss-of-a-human-hand-a-personal-view/434376.png","ImageObject",300,407,{"name":92,"@type":93},"Riley West","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How does the author compare prosthetic care with allotransplantation after upper-limb loss?","Question",{"text":112,"@type":113},"He contrasts prostheses with hand transplantation as different ways to restore function. The article explains what each approach can offer and highlights trade-offs from his clinical experience and perspective.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What was the purpose of initiating the Leeds hand transplantation service?",{"text":117,"@type":113},"The service aimed to treat patients and to curate and report a prospective cohort over decades using a uniform, protocol-driven system.",{"name":119,"@type":110,"acceptedAnswer":120},"Why does the author introduce a “third R” beyond Repair and Reconstruction?",{"text":121,"@type":113},"For an upper-limb stump, Repair and Reconstruction may not be applicable, so “replacement” becomes the practical concept that addresses the need to restore form and function.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},434376,1791169987,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},1099523885074,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","JPRAS Open 47 (2025) 51–54  \nContents lists available at ScienceDirect  \nJPRAS Open  \njournal [homepage:](homepage: www.elsevier.com/locate/jpra)[ www.elsevier.com/locate/jpra](homepage: www.elsevier.com/locate/jpra)  \n| Original Article\u003Cbr>Restitution or substitution after loss of a human hand: A personal view\u003Cbr>Simon P.J. Kay\u003Cbr>Consultant Plastic Surgeon, Leeds Teaching Hospitals NHS Trust, Great George St, Leeds LS1 3EX, West Yorkshire UK |  |  |\n| --- | --- | --- |\n| a r t i c l e i n f o |  | a b s t r a c t |\n| Article history:\u003Cbr>Received 31 July 2025\u003Cbr>Accepted 3 August 2025\u003Cbr>Available online 17 August 2025 |  | The author summarises the differences between prosthetic care and allotransplantation in managing upper limb loss.\u003Cbr>© 2025 The Author. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license\u003Cbr>([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)) |\n| Keywords:\u003Cbr>Upper limb\u003Cbr>Prosthesis\u003Cbr>Amputtaion\u003Cbr>Allotransplantation of upper limb Hand transplant |  |  |\n\nIn 2010, a group of surgeons in Leeds,1 prompted by colleagues in solid organ transplantation, began the process of building support for the establishment of a hand transplantation service. None of us knew much about the field, and indeed, even a decade after the first successful hand transplants, there was little in the way of firm, reliable, evidence-based knowledge. That has changed only slowly, in large part due to the sporadic and uncontrolled nature of the small series of hand transplants conducted globally to date. The Leeds service was initiated with the dual intentions of treating patients and curating and reporting a prospective cohort over decades within a uniform, protocol-driven system.  \nDeveloping the service began with securing the confidence of key stakeholders, including NHSBT, i BAPRAS, ii NICE, iii and BSSH.iv Under the commissioning arrangements of the time, the most crucial support came from Leeds Teaching Hospitals, who generously agreed that the first two procedures  \nE-mail address: [simon.kay@nhs.net](simon.kay@nhs.net)  \ni National Health Service Blood and Transplant: the sole organ procurement organization in the UK. ii British Association of Plastic, Reconstructive and Aesthetic Surgeons.  \niii National Institute for Health and Care Excellence.  \niv British Society for Surgery of the Hand.  \n[https://doi.org/10.1016/j.jpra.2025.08.011](https://doi.org/10.1016/j.jpra.2025.08.011)  \n2352-5878/© 2025 The Author. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license  \n([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/))  \nS.P.J. Kay JPRAS Open 47 (2025) 51–54  \nwould be undertaken “at risk’’—that is, with the Trust absorbing the costs upfront, hoping to recover them from the purchaser (primary care) post hoc.  \nWe received generous and unstinting support from the hand transplant team in Lyon, France, under the leadership of Aram Gazarian and Emmanuel Morelon, who at that time had the greatest European experience in vascularized allotransplantation.2  \nShortly after Christmas 2012, we performed our first transplant: a unilateral graft replacing a functionless hand in a patient who had lost almost all mobility following severe infection. His contralateral hand was compromised by gouty arthritis.  \nSince that first case, we have transplanted 20 limbs in 11 patients—now the largest and most diverse experience in the Western world. We have encountered our first failure (one limb of a bilateral transplant, abandoned intraoperatively due to idiopathic systemic shock) and one long-term, unrelated death three years post-transplant.  \nEmerging fields in surgery inevitably challenge our assumptions and offer fre","cbCaioteVhw8kFYD","https://ap.wps.com/l/cbCaioteVhw8kFYD","pdf",221409,"English","# Article history and overview\n## Service development in Leeds\n## Early cases and long-term outcomes\n## “Three Rs” framework: Repair, Reconstruction, Replacement\n## Prosthetics vs allotransplantation\n## Control challenges and future directions","[{\"question\":\"How does the author compare prosthetic care with allotransplantation after upper-limb loss?\",\"answer\":\"He contrasts prostheses with hand transplantation as different ways to restore function. The article explains what each approach can offer and highlights trade-offs from his clinical experience and perspective.\"},{\"question\":\"What was the purpose of initiating the Leeds hand transplantation service?\",\"answer\":\"The service aimed to treat patients and to curate and report a prospective cohort over decades using a uniform, protocol-driven system.\"},{\"question\":\"Why does the author introduce a “third R” beyond Repair and Reconstruction?\",\"answer\":\"For an upper-limb stump, Repair and Reconstruction may not be applicable, so “replacement” becomes the practical concept that addresses the need to restore form and function.\"}]","Restitution or substitution after loss of a human hand - A personal view | PDF",1790668858]