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印度次大陆首例双侧髁上水平上肢移植手术。

Indian Subcontinent's First Bilateral Supracondylar Level Upper Limb Transplantation.

作者信息

Sharma Mohit, Iyer Subramania, P Kishore, Mathew Jimmy, R Janarthanan, Maharaja Nirav, Dhake Swapnil, Omkumar Akshay, Joe Thomas, Sharma Dimpy, Kapathia Radhika, Harijee Ankita, Reddy Srilekha, Paul Jerry, Rajan Sunil, Kurian George, Paul Zacharia, Shaji Druvan, Babu Balu C, Sharma Anubhav

机构信息

Department of Plastic and Reconstructive Surgery; Amrita Institute of Medical Science, Kochi, Kerala, India.

Department of Anaesthesiology, AIMS Kochi; Amrita Institute of Medical Science, Kochi, Kerala, India.

出版信息

Indian J Plast Surg. 2019 Sep;52(3):285-295. doi: 10.1055/s-0039-3401466. Epub 2019 Dec 26.

DOI:10.1055/s-0039-3401466
PMID:31908366
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6938436/
Abstract

This is the first case of supracondylar level transplant from the Indian subcontinent, performed for a bilateral below elbow amputee. It has a completely different set of challenges for the transplant team, with a relatively shorter ischemia time window. The technical considerations for the same have been discussed in detail in this article. The patient was a 19-year-old female who lost her both upper limbs at proximal forearm level due to severe crush injury following a road traffic accident. Insufficient bone length on either side necessitated a supracondylar level transplant. The preoperative workup included detailed clinical evaluation, biochemical, and psychological evaluation. The donor was a young brain-dead, male patient from a hospital, 30 minutes away. The donor and recipient preparations in this case were unique. The recipient's own elbow flexors and extensors were used while the elbow joint was from the donor. The specific challenges we faced during this procedure have been described in detail. The transplantation has been a complete technical success, with the patient rehabilitated back to her independent life style. This article describes only the technical considerations. The functional recovery aspect is part of an another soon to be published manuscript. Supracondylar level arm-transplant requires a highly coordinated team effort with precise preoperative planning, along with meticulous attention to detail to achieve a successful outcome. In properly selected patients, it could be a life-changing procedure, worth all the effort.

摘要

这是印度次大陆首例髁上水平移植手术，为一名双侧肘下截肢患者实施。对于移植团队而言，这带来了一系列截然不同的挑战，缺血时间窗相对更短。本文已详细讨论了相关技术要点。患者为一名19岁女性，因道路交通事故导致严重挤压伤，双侧上肢在前臂近端水平截肢。双侧骨长度不足使得髁上水平移植成为必要。术前检查包括详细的临床评估、生化及心理评估。供体是一名来自30分钟车程外一家医院的年轻脑死亡男性患者。该病例中供体和受体的准备工作独具特色。受体自身的肘屈肌和伸肌被保留，而肘关节取自供体。我们在该手术过程中面临的具体挑战已详细描述。移植手术在技术上取得了圆满成功，患者已恢复到独立生活状态。本文仅描述技术要点。功能恢复方面是另一篇即将发表的稿件的内容。髁上水平手臂移植需要高度协作的团队努力，精确的术前规划以及对细节的一丝不苟，才能取得成功。对于经过恰当挑选的患者而言，这可能是一个改变人生的手术，一切努力都值得。

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本文引用的文献

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Ischemia/reperfusion injury in vascularized tissue allotransplantation: tissue damage and clinical relevance.血管化组织同种异体移植中的缺血/再灌注损伤：组织损伤与临床相关性。
Curr Opin Organ Transplant. 2016 Oct;21(5):503-9. doi: 10.1097/MOT.0000000000000343.
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Peripheral nerve injury grading simplified on MR neurography: As referenced to Seddon and Sunderland classifications.磁共振神经成像简化的周围神经损伤分级：参考塞登和桑德兰分类法
Indian J Radiol Imaging. 2014 Jul;24(3):217-24. doi: 10.4103/0971-3026.137025.
3
Above-elbow (supracondylar) arm transplantation: clinical considerations and surgical technique.
肘上（髁上）臂移植：临床考量与手术技术
Tech Hand Up Extrem Surg. 2013 Dec;17(4):221-7. doi: 10.1097/BTH.0000000000000026.
4
Vascularized composite allotransplantation: an update on medical and surgical progress and remaining challenges.血管化复合组织同种异体移植：医学和手术进展及尚存挑战的最新综述。
J Plast Reconstr Aesthet Surg. 2013 Nov;66(11):1449-55. doi: 10.1016/j.bjps.2013.06.037. Epub 2013 Jul 16.
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Result of arm-level upper-limb transplantation in two recipients at 19- and 30-month follow-up.两名接受者上肢移植术后19个月和30个月随访结果。
Ann Transplant. 2012 Jul-Sep;17(3):126-32. doi: 10.12659/aot.883467.
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The International Registry on Hand and Composite Tissue allotransplantation.国际手部及复合组织异体移植登记处。
Clin Transpl. 2011:247-53.
7
Surgical and technical aspects of hand transplantation: is it just another replant?手部移植的手术及技术层面：它只是另一种再植手术吗？
Hand Clin. 2011 Nov;27(4):521-30, x. doi: 10.1016/j.hcl.2011.08.001. Epub 2011 Sep 21.
8
Favoring the risk-benefit balance for upper extremity transplantation--the Pittsburgh Protocol.支持上肢移植的风险效益平衡——匹兹堡方案
Hand Clin. 2011 Nov;27(4):511-20, ix-x. doi: 10.1016/j.hcl.2011.08.008.
9
Bilateral trans-humeral arm transplantation: result at 2 years.双侧肱骨移植术：2 年随访结果。
Am J Transplant. 2011 May;11(5):1085-90. doi: 10.1111/j.1600-6143.2011.03503.x.
10
Composite tissue allotransplantation.复合组织同种异体移植。
Plast Reconstr Surg. 2009 Dec;124(6 Suppl):e327-e339. doi: 10.1097/PRS.0b013e3181bf8413.