Avascular necrosis of the humeral head following bilateral upper extremity vascular composite allotransplantation: a case report

Rinkinen, Jacob; Molway, David; Carty, Matthew J.; Dyer, George S.M.; Pomahac, Bohdan; Chandraker, Anil; Talbot, Simon G.

doi:10.1080/23320885.2017.1345635

Cited by 5 publications

(2 citation statements)

References 17 publications

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“…The patient underwent arthroplasties with total hip replacements at the second and sixth years posttransplantation. Rinkinen et al () described the other patient who developed unilateral AVN of the humeral head at 15 months posttransplantation following the initial induction steroid treatment and two subsequent pulse steroid courses for rejection episodes. The patient underwent a conservative nonsurgical intervention and management with ongoing physical and occupational therapy.…”

Section: Discussionmentioning

confidence: 99%

Bone infarction of the hip after hand allotransplantation: A case report

et al. 2018

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Vascularized composite allotransplantation represents as an emerging field in reconstructive surgery. However, some complications can be associated with the procedure. The authors describe a case of bone infarctions of the bilateral hip joints following the first hand allotransplantation in Taiwan. A 45‐year‐old man who experienced a traumatic amputation of the distal third of his forearm received a hand transplantation from a brain‐dead donor. Immunosuppression included antithymocyte globulins, and bolus methylprednisolone (Solu‐Medrol) was used for the induction. The maintenance therapy protocol included systemic tacrolimus, mycophenolate mofetil, and prednisone. The patient discontinued the systemic steroid 15 months after surgery. Two episodes of acute rejections were observed at 105 and 810 days after surgery. These signs disappeared after pulse therapy with Solu‐Medrol, titration with tacrolimus, and topical immunosuppressive creams (tacrolimus and clobetasol). However, the patient felt pain in both hips after long periods of standing 30 months after the transplantation. A pelvic radiograph and magnetic resonance imaging revealed avascular necrosis (AVN) in both hip joints. Because of the progressive worsening of the pain, the patient underwent a decompression surgery on the left hip involving a fibula bone graft. The patient underwent a right hip hemi‐arthroplasty with a bipolar prosthesis 3 months later. The patient remained in good health without major complications. These findings indicate that systemic steroids and tacrolimus might be the major predisposing factors for the induction of AVN after hand allotransplantation.

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Section: Discussionmentioning

confidence: 99%

Bone infarction of the hip after hand allotransplantation: A case report

et al. 2018

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“…16,17 After transplantation, subclinical AVN may be exacerbated by the additional weight and use applied through these joints and by the osteoporotic effect of corticosteroids as part of the immunosuppression regimen. 18 In postsepsis patients being evaluated for hand transplantation, restricted mobility and weight-bearing opportunities may conceal this diagnosis, with clinical evidence of joint destruction only coming to light during rehabilitation. 19 We recommend a high index of suspicion for subclinical, postsepsis AVN, with careful musculoskeletal assessment during workup, attempts to minimize corticosteroid doses, and consideration given to consenting patients for possible joint replacement.…”

Section: Avascular Necrosis Of Bonementioning

confidence: 99%

The Nuances of Hand Transplantation After Sepsis

et al. 2023

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Vascularized composite allotransplantation (VCA) of the upper extremity is an established restorative procedure for selected patients with acquired upper limb loss. The majority of upper limb VCAs performed worldwide have been for victims of various forms of trauma. However, in the developed world, amputation following severe sepsis seems to be an increasingly common indication for referral to hand transplant programs. Unlike trauma patients with isolated limb injuries, patients with amputations as a complication of sepsis have survived through a state of global tissue hypoperfusion and multisystem organ failure with severe, enduring effects on the entire body's physiology. This article reviews the unique considerations for VCA candidacy in postsepsis patients with upper limb amputation. These insights may also be relevant to postsepsis patients undergoing other forms of transplantation or to VCA patients requiring additional future solid organ transplants. (Transplantation 2024;108: 319-322). Renal FailureSepsis is the leading cause of acute renal failure in critically ill patients. Many patients require dialysis during their

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Ethics and the Future of Vascularized Composite Allotransplantation

Benedict

Magill

2018

Curr Transpl Rep

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Avascular necrosis of the humeral head following bilateral upper extremity vascular composite allotransplantation: a case report

Cited by 5 publications

References 17 publications

Bone infarction of the hip after hand allotransplantation: A case report

Bone infarction of the hip after hand allotransplantation: A case report

The Nuances of Hand Transplantation After Sepsis

Ethics and the Future of Vascularized Composite Allotransplantation

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