Elsaftawy Ahmed, Jagosz Marta, Smorąg Maja, Węgrzyn Piotr, Kamińska Dorota, Bonczar Michał, Ostrowski Patryk
From the Department of Plastic and Hand Surgery, St. Jadwiga Śląska Hospital, Trzebnica, Poland.
Wrocław University of Science and Technology, Wrocław, Poland.
Plast Reconstr Surg Glob Open. 2025 Jun 10;13(6):e6893. doi: 10.1097/GOX.0000000000006893. eCollection 2025 Jun.
Vascularized composite allotransplantation provides upper limb amputation patients with functional and aesthetic restoration but is limited by the challenges of chronic rejection. This case report highlights a patient who underwent right-hand transplantation and experienced repeated rejection episodes, chronic pain, and functional decline. Despite standard immunosuppressive regimens and innovative interventions such as fat grafting with platelet-rich plasma, chronic rejection symptoms persisted. Fat grafting demonstrated short-term improvements in skin texture and inflammation but failed to prevent progressive deterioration. Ultimately, the patient opted for reamputation, prioritizing quality of life over the prolonged burden of managing a failing graft. This case showcases the complexities of managing chronic rejection in vascularized composite allotransplantation and highlights the need for individualized, patient-centered approaches that respect autonomy and prioritize overall well-being.
血管化复合组织异体移植为上肢截肢患者提供了功能和美观的恢复，但受到慢性排斥反应挑战的限制。本病例报告重点介绍了一名接受右手移植的患者，该患者经历了反复的排斥反应、慢性疼痛和功能衰退。尽管采用了标准的免疫抑制方案以及诸如富含血小板血浆的脂肪移植等创新干预措施，但慢性排斥反应症状仍持续存在。脂肪移植在短期内改善了皮肤质地和炎症，但未能阻止病情的逐渐恶化。最终，患者选择再次截肢，将生活质量置于管理失败移植的长期负担之上。本病例展示了血管化复合组织异体移植中管理慢性排斥反应的复杂性，并强调了需要采取尊重自主性并优先考虑整体福祉的个体化、以患者为中心的方法。
