Newswise — Many soldiers returning from combat bear visible scars, or even lost limbs, caused by blasts from improvised explosive devices, or IEDs. However, some servicemen also return with debilitating hidden injuries -- the loss of all or part of their genitals. Now, the Johns Hopkins reconstructive surgery team that performed the country's first bilateral arm transplant in a wounded warrior has successfully performed the first total penis and scrotum transplant in the world.
"We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man," says W.P. Andrew Lee, M.D., professor and director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine.
A team of nine plastic surgeons and two urological surgeons was involved in the 14-hour surgery on March 26. They transplanted from a deceased donor the entire penis, scrotum (without testicles) and partial abdominal wall.
"It's a real mind-boggling injury to suffer, it is not an easy one to accept," says the recipient who is a veteran who sustained injuries in Afghanistan and wishes to remain anonymous. "When I first woke up, I felt finally more normal... [with] a level of confidence as well. Confidence... like finally I'm okay now," he says.
The recipient is a veteran who sustained injuries in Afghanistan and wishes to remain anonymous. He has recovered from the surgery and is expected to be discharged from the hospital this week.
While it's possible to reconstruct a penis using tissue from other parts of the body, says Lee, a prosthesis implant would be necessary to achieve an erection, and that comes with a much higher rate of infection. Additionally, due to other injuries, servicemen often don't have enough viable tissue from other parts of their bodies to work with.
This type of transplant, where a body part or tissue is transferred from one individual to another, is called vascularized composite allotransplantation. The surgery involves transplanting skin, muscles and tendons, nerves, bone and blood vessels. As with any transplant surgery, tissue rejection is a concern. The patient is put on a regimen of immunosuppressive drugs to prevent rejection. Lee's team has developed an immune modulation protocol aimed at minimizing the number of these drugs needed to prevent rejection.
HEALTH CARE NEWS
US Congress extends CHIP, funds opioid crisis response following temporary shutdown
Publish date: February 9, 2018
Congress, despite a second shutdown in less than a month, was able to pass a number of financial extenders to fund key health care programs.
The bipartisan spending bill (H.R. 1892), passed in the early morning hours on Feb. 9 by a 71-28 vote in the Senate (16 Republicans and 12 Democrats voted against it, and Sen. John McCain [R-Ariz.] was not present) and a 240-186 vote in the House (67 Republicans and 119 Democrats voted against and 5 representatives did not vote). President Trump signed the bill later that morning.
The spending bill and continuing resolution to fund the government through March 23 includes $6 billion to fund treatment for opioid addiction and other mental health issues, $2 billion in additional funding for the National Institutes of Health, and 4 additional years of funding for the Children’s Health Insurance Program. The additional CHIP funding extends the program for a total of 10 years.
The funding bill also made a technical correction to the Merit-based Incentive Payment System (MIPS) track of the Medicare Quality Payment Program. It removes Part B drug reimbursement from the MIPS payment adjustment, so any positive or negative change to physician payments based on the MIPS score will only be applied to physician fee schedule payments.
The bill also repeals the Independent Payment Advisory Board, a panel created by the Affordable Care Act that would have the power to slash Medicare spending under certain budget circumstances. That board was never convened.
The funding legislation also accelerates closure of the Medicare Part D “donut hole,” the coverage gap in which beneficiaries must pay 100% of medication costs prior to entering catastrophic coverage.
Just over $7 billion was provided for community health centers and Medicare’s therapy caps were repealed.
While the funding bill was written in the Senate with bipartisan input and received bipartisan support, Sen. Rand Paul (R-Ky.) held up votes over objections to the more than $1 trillion it will add to the nation’s debt, as well as for the fact that there was no opportunity to introduce and vote on amendments, leading to an hours-long government shutdown.
There also were concerns about two issues that could have derailed the vote in the House. Democrats wanted to add language to address immigrants brought to this nation illegally as children, while some Republicans did not want to increase the federal debt. However, there were enough votes to pass the funding legislation.