By James R. Fowler, MD

It is a privilege to write for the ASSH perspective and what I have not done in my career, but would like to do.

I had nearly two simultaneous careers; both were very busy and rewarding. I served in the Navy Medical Corps, both active and reserve, for thirty-eight years. I did Hand Surgery for much of that time; having been in private practice, academia and teaching. I have seen and done new surgical procedures as they developed.

The one thing I have not been personally involved is hand transplantation. At this late stage in my career, I doubt that I will and that is what I regret. I did follow the progress and advancement of this unique and useful procedure and encourage all to do so.

Hand transplantation was not always accepted as the appropriate thing to do. Even some leaders in Hand Surgery at the time did not think it was a good idea. This has been true of other new procedures as well that are now considered common place. Examples are primary repair of flexor tendons in Zone II, so called ‘no man’s land,’ and even microsurgery itself was slow to be accepted by some.

Re-implantation after amputation, toe-to-thumb transfers, free flaps for reconstruction, and closure of difficult defects were not automatically and universally accepted. Nerve repair and grafting also had a growing period.

I hope to instill in the residents and young Hand Surgeons to look critically at all new surgical procedures and adopt and support those that are helpful to our patients. Hand transplantation is such a procedure.

Unfortunately, military conflicts will continue and are a major cause of extremity loss. Civilian and industrial accidents will also add to the problem. Transplantation needs to continue and improve. I am sure it will. Having trained with Dr. Kleinert and Kutz in Louisville, I saw many new and innovative techniques and procedures.

Unfortunately for me, I left before Dr. Warren Breidenbach headed the Louisville team and did the first successful hand transplant in the United States on January 24-25, 1999. Mathew Scott celebrated the twentieth anniversary of his transplant on March 5, 2019, and was made an honorary citizen of Louisville.  

The first hand transplant was done in Lyon, France September 23, 1998. It had to be removed about two and a half years later for a multitude of reasons.

The Louisville team did everything right and I congratulate them. The entire team approached this new procedure absolutely correct. Proper patient selection was essential. The team included a large group of dedicated professionals; including the transplant physicians, psychologists, immunologists, pathologists and pharmacologists and hand therapists. Equally important for success was appropriate and closely followed therapy and long-term support of the patient and his family.

I feel blessed to have had two careers that I have totally enjoyed. I wish I could start over. I advise and encourage trainees and young hand surgeons to learn from the past and use proven techniques. However, good surgeons should not be too quick to reject future new procedures. They should do appropriate ones and even create new ones.

I am sure we will and that will be reward enough for me.

RADM James R. Fowler, MC, USNR (ret)