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Composite tissue allograft transplantation is a recognized option for reconstruction in upper limb amputees. Sirolimus is an immunosuppressive drug that prevents organ rejection and improves kidney function, but its use has been associated with impaired healing. Two recipients of bilateral hand allografts underwent arthrodeses of 6 joints as secondary procedures while being treated with sirolimus. We found no clinical or radiologic evidence of bone healing delay or bone nonunion. The functional evaluation revealed an improvement in the performance of activities of daily living after the transplant and secondary procedures. We conclude that bone surgery can be performed safely in recipients of hand allografts who are receiving sirolimus-based immunosuppressive therapy.

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Background Breast cancer‐related lymphoedema (BCRL) presents a significant healthcare burden and adversely affects quality of life of breast cancer survivors. A prospective feasibility study was performed on lymphaticovenous anastomosis (LVA) for the treatment of BCRL. Methods Patients with BCRL underwent near‐infrared spectroscopy with indocyanine green lymphatic mapping to identify suitable lymphatic channels for LVA. End‐to‐end anastomoses to subdermal venules were performed and patients recommenced compression garment therapy (CGT) after surgery. Volumetric assessment of the affected limb was performed at regular intervals using infrared perometry to calculate the excess volume reduction. Results Over a 24‐month interval, 27 patients with BCRL underwent LVA. The mean duration of lymphoedema was 3·5 (range 0·5–18) years, and the mean number of LVAs performed was 3 (range 2–5). Twenty‐four of the 27 patients completed 12‐month follow‐up. Patients exhibited three patterns of volumetric response following LVA: sustained response (16 patients), transient response (5) or no response (6). Sustained responders showed an excess volume reduction of −33·2 per cent at 12 months, and this correlated positively with the number of LVAs performed (r = −0·56, P = 0·034). Overall, ten patients were able to downgrade CGT after surgery, and two patients were CGT‐free at 12 months. Conclusion LVA resulted in a sustained volume reduction in selected patients and may offset the burden of CGT. Further work is required to identify biomarkers that predict a favourable response to LVA surgery.

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