Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
Kootenay Surgery Clinic, Trail, British Columbia, Canada.
Hand (N Y). 2021 May;16(3):391-396. doi: 10.1177/1558944719863127. Epub 2019 Jul 23.
Hand and distal forearm allotransplantation has advanced over the last 20 years from experimental to a viable treatment option for bilateral upper extremity amputation. Despite widespread growth of this field, there are few technical reports that elaborate the details of donor arm procurement. This article details a technique for rapid donor procurement through the elbow for mid to distal forearm-level hand allograft procurement. Nine arm procurements were performed on deceased tissue-only donors provided by the local organ procurement organization, including two bilateral and five unilateral cases. Technique highlights include using a fishmouth incision through the lateral and medical epicondyles, identification of the neurovascular structures, and disarticulating the elbow joint. Procuring through the elbow provides straightforward anatomy, bypasses the need to cut through bone, and allows tissue allotransplantation teams to achieve procurement, flushing, and packaging within 20 minutes. Procurement through the elbow is a simple procedure that streamlines the process for multi-organ donors by minimizing the time needed for hand allograft procurement. Team coordination and surgical rehearsals are essential for successful hand and upper extremity procurement and allotransplantation.
手部和远端前臂同种异体移植在过去 20 年中从实验进展到成为双侧上肢截肢的可行治疗选择。尽管该领域得到了广泛发展，但很少有技术报告详细阐述供体臂获取的细节。本文详细介绍了一种通过肘部进行快速供体获取的技术，用于中至远端前臂水平的手部同种异体移植获取。在当地器官获取组织的支持下，对 9 例仅组织供体进行了手臂获取，包括 2 例双侧和 5 例单侧病例。技术要点包括使用鱼口形切口穿过外侧和内侧肘突，识别神经血管结构，并分离肘关节。通过肘部进行获取提供了直接的解剖结构，避免了切割骨骼的需要，并使组织同种异体移植团队能够在 20 分钟内完成获取、冲洗和包装。通过肘部进行获取是一种简单的程序，通过最小化手部同种异体移植获取所需的时间，简化了多器官供体的流程。团队协调和手术排练对于成功的手部和上肢获取和同种异体移植至关重要。
