First Polish forearm transplantation: report after 17 months.

INTRODUCTION

The number of hand transplantations is increasing every year prompted by promising results. Still, the number of transplantations performed at the level of midforearm/elbow is relatively small. The aim of the study was to evaluate after 17 months postoperatively the result of the first Polish upper limb transplantation performed at midforearm level.

MATERIALS AND METHODS

The transplant recipient was a 32-year-old man, who lost his right, dominant upper limb at the level of midforearm in an accident 14 years prior. After a comprehensive pretransplantation evaluation and informed consent process we transplanted a right forearm matched for size and skin tone from a 47-year-old brain-dead man. The donor's limb amputated at the elbow was irrigated with University of Wisconsin solution. We dissected donor and recipient limbs simultaneously. The cold ischemia time was 10.5 hours. Immunosuppression included Simulect, tacrolimus, mycophenolic acid, and prednisone. Maintenance therapy included tacrolimus, mycophenolic acid, and Encorton.

RESULTS

There were no intraoperative or early postoperative complications, except for delayed wound healing. No episodes of rejection were observed. Immunosuppression was well tolerated. In the process of physiotherapy, a continuous passive motions device was applied, as well as special tests to stimulate tactile sensation. After 11 months, Tinel's sign reached the finger pulps innervated by the ulnar nerve and after 12 months, by the median nerve. The monofilament test/Semmens-Weinstein was positive after 17 months: blue for ulnar nerve and purple for median nerve. The sensations proved grade 3+ and grade 3, respectively. The activity of intrinsic muscles was not detectable by electromyography; active range of motion included 63% of the unaffected hand. The extremity excellently matched the contralateral hand for size, color, and skin texture. The patient uses his hand for writing, riding his bike, and a mobile phone. The total Lanzetta' score was excellent (82 points).