Haddock Nicholas T, Chang Benjamin, Bozentka David J, Steinberg David R, Levin Lawrence Scott
Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA.
Tech Hand Up Extrem Surg. 2013 Dec;17(4):228-31. doi: 10.1097/BTH.0000000000000025.
The field of vascularized composite allotransplantation has developed for more than a decade. Investigators are defining patient selection criteria, transplant indications, immunologic regimens, and tolerance. The majority of the current reported hand transplantations have been for treatment of distal forearm or hand amputations. In more proximal amputees, the functional outcome of the transplanted arm has some unique variables that require a different surgical approach. We present a single case of bilateral proximal forearm transplantation in effort to describe the unique technical considerations in this complex procedure. The surgical procedure is described in detail. At 19 months, our patient had 4/5 strength of finger and thumb flexors and protective extensor as well as 4/5 wrist flexors and extensors. Our patient had recovery of sensation. Our patient now lives independently and does her lower extremity prosthesis independently using her hands. These results are expected to continue to improve with more time. In hand transplantation, functional results have been very promising. The described approach of forearm transplantation allows the transfer of the entire functional unit, which should optimize the ultimate outcome for these more proximal injuries.
血管化复合组织异体移植领域已经发展了十多年。研究人员正在确定患者选择标准、移植适应症、免疫方案和耐受性。目前报道的大多数手部移植手术都是用于治疗前臂远端或手部截肢。对于更近端截肢的患者，移植手臂的功能结果有一些独特的变量，需要不同的手术方法。我们报告一例双侧近端前臂移植病例，旨在描述这一复杂手术中独特的技术要点。详细描述了手术过程。术后19个月，我们的患者手指和拇指屈肌力量为4/5，有保护性伸肌功能，腕部屈肌和伸肌力量也为4/5。患者感觉功能得以恢复。我们的患者现在能够独立生活，并且能用手独立穿戴下肢假肢。随着时间推移，这些结果有望持续改善。在手部移植中，功能结果非常令人鼓舞。所描述的前臂移植方法能够转移整个功能单元，这应该会优化这些更近端损伤的最终治疗效果。
