Jabłecki Jerzy, Kaczmarzyk Leszek, Domanasiewicz Adam, Chełmoński Adam, Kaczmarzyk Janusz
Department of General Surgery, Sub department of Hand Surgery and Replantation of Limbs, St Jadwiga Slaska Hospital, Prusicka 53 Str., Trzebnica, Poland.
Ann Transplant. 2010 Jan-Mar;15(1):53-6.
The technique of hand transplantation is similar to that of hand replantation. Although the rate of failure of hand replantation tantamount to 15% on average, depending mostly on mechanism of amputation, until now no data have been published concerning the failure of attempts of hand transplantation.
A 42-year-old male is presented who was the recipient of a hand transplant. The patient had an amputation of his left, dominant forearm (result of a circular-saw accident) 8 years prior to the transplantation. He was generally healthy, very dedicated to the operation. The limb was obtained in another hospital from a 49-year-old woman, victim of an accident and multi visceral donor.The donor was matched for blood group (0 positive), bone size, texture, with the recipient. There was 4 HLA antigen mismatch; the lymphocytotoxic cross-match was negative. The operation was performed in a sequence as follows: bones--muscles--nerves--veins--arteries--skin. The induction IT consisted of Simulect, Prograff, Cell-Cept, and steroids; the pharmacotherapy was standard as for a forearm replantation. The cold ischemia time was 9 hours. Soon after the transplantation the disturbances of blood circulation in the transplanted forearm were to be seen. High doses of macromolecular heparin were applied resulting in temporary improvement. During following hours despite various precautions the symptoms of ischemia of the hand up to 1/3 distal part of the forearm dramatically increased. The revision (performed 12 hrs after completing the transplantation) proved a massive thrombosis of hand arteries, and a large clot of the radial artery in locus of it's cannulation for invasive blood pressure measurement. The limb had to be re-amputated. As it came clear the arterial catheter was removed 6 hours prior to procurement.
The hand transplant are not free from non-immunological typical vascular complications. The arterial catheters should not be applied in limbs destined for procurement.
手部移植技术与手部再植技术相似。尽管手部再植的失败率平均达15%，主要取决于截肢机制，但目前尚无关于手部移植尝试失败的相关数据发表。
本文介绍了一位接受手部移植的42岁男性患者。该患者在移植手术8年前因圆锯事故导致左优势前臂截肢。他总体健康状况良好，对手术充满期待。供肢取自另一家医院的一名49岁女性，该女性因事故死亡且为多器官捐献者。供体与受体血型匹配（O型阳性），骨骼大小、质地匹配。有4个HLA抗原不匹配；淋巴细胞毒性交叉配型为阴性。手术按以下顺序进行：骨骼 - 肌肉 - 神经 - 静脉 - 动脉 - 皮肤。诱导免疫抑制治疗包括舒莱、普乐可复、骁悉和类固醇；药物治疗与前臂再植的标准相同。冷缺血时间为9小时。移植后不久，移植的前臂出现血液循环障碍。应用大剂量大分子肝素后症状暂时改善。在接下来的几个小时里，尽管采取了各种预防措施，但手部直至前臂远端三分之一处的缺血症状仍急剧加重。翻修手术（在移植完成后12小时进行）证实手部动脉出现大量血栓形成，且在用于有创血压测量的桡动脉插管部位有一大块血栓。该肢体不得不再次截肢。后来发现，在获取供肢前6小时已拔除动脉导管。
手部移植并非没有非免疫性典型血管并发症。不应在准备获取的肢体上应用动脉导管。
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