Plastic Surgery Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Resident of General Surgery, The American British Cowdray Medical Center, Mexico City, Mexico.
Transplantation. 2020 Apr;104(4):e90-e97. doi: 10.1097/TP.0000000000003083.
Although return of function has been reported in patients undergoing proximal forearm transplantations (PFTs), reports of long-term function are limited. In this study, we evaluated the clinical progress and function 7 years postoperatively in a patient who underwent bilateral PFT.
A 58-year-old man underwent bilateral PFT in May 2012. Transplantation involved all of the flexor and extensor muscles of the forearm. Neurorrhaphies of the median, ulnar, and radial nerves were epineural and 7 cm proximal to the elbow. Immunosuppressive maintenance medications during the first 3 years postoperatively were tacrolimus, mycophenolate, and steroids, and later, tacrolimus, sirolimus, and steroids. Forearm function was evaluated annually using the Disabilities of the Arm, Shoulder, and Hand; Carroll; Hand Transplantation Score System; Short Form-36; and Kapandji scales. We also evaluated his grip and pinch force.
Postoperatively, the patient developed hypertriglyceridemia and systemic hypertension. He experienced 6 acute rejections, and none were resistant to steroids. Motor function findings in his right/left hand were: grip strength: 10/13 kg; key pinch: 3/3 kg; Kapandji score: 6/9 of 10; Carroll score: 66/80; Hand Transplantation Score System score: 90/94. His preoperative Disabilities of the Arm, Shoulder, and Hand score was 50 versus 18, postoperatively; his Short Form-36 score was 90. This function improved in relation with the function reported in the second year.
Seven years following PFT, the patient gained limb strength with a functional elbow and wrist, although with diminished digital dexterity and sensation. Based on data presented by other programs and our own experience, PFT is indicated for select patients.
尽管已经有报道称接受前臂近端移植（PFT）的患者功能恢复，但长期功能的报道有限。在这项研究中，我们评估了一位接受双侧 PFT 患者术后 7 年的临床进展和功能。
一名 58 岁男性于 2012 年 5 月接受双侧 PFT。移植包括整个前臂的屈肌和伸肌。正中、尺神经和桡神经的神经吻合采用神经外膜技术，位于肘部近端 7 厘米处。术后前 3 年的免疫抑制维持药物为他克莫司、霉酚酸酯和类固醇，随后为他克莫司、西罗莫司和类固醇。每年使用上肢残疾、肩手和卡罗尔评估前臂功能；手移植评分系统；简短形式-36；和 Kapandji 量表。我们还评估了他的握力和捏力。
术后患者出现高甘油三酯血症和系统性高血压。他经历了 6 次急性排斥反应，均无类固醇耐药。右手/左手的运动功能发现为：握力：10/13 公斤；关键捏力：3/3 公斤；Kapandji 评分：10 分中的 6/9；卡罗尔评分：66/80；手移植评分系统评分：90/94。他术前的上肢残疾、肩手和手的评分是 50 分，术后是 18 分；他的简短形式-36 评分是 90 分。与第二年报告的功能相比，这种功能有所改善。
PFT 后 7 年，患者上肢力量增强，肘部和腕部功能正常，尽管手指灵活性和感觉下降。根据其他计划和我们自己的经验提供的数据，PFT 适用于特定患者。
