Cadaveric Bilateral Proximal Forearm Allotransplantation

Sivakumar, Dinesh Kumar; Chavan, Vinayak; Chittoria, Ravi Kumar; Thiruvoth, Friji Meethale; Mohapatra, Devi Prasad; Subbarayan, Elankumar; Reddy, Konda Sireesha; Babu, Preethitha; Kumaran, Senthil; Aggarwal, Abhinav; Guptha, Saurabh

doi:10.1097/sap.0000000000001829

Cited by 6 publications

(3 citation statements)

References 4 publications

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“…Although prostheses are continuously improving in term of autonomous control and complex movements as technology progresses,theystillhavestillmajorlimitationsintheseaspects,aswellas limited functions and high cost. The functional outcomes in patients undergoing transplantation have been better than those in patients fittedwithprostheses [5,6]eventhoughpostoperativeneuralgia, sensory disturbances, scar adhesion, and ischemic contracture may be present in the former. Even so, postoperative satisfaction was high, and postoperative function was better than it has been in those fittedwithprostheses.Inthisstudy,theincidenceofcomplications after replantation was 84 %, and the DASH score was 36.80 ± 15.77.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of three different nerve repair strategies (repair, autografting and allografting) in one-stage replantation to treat upper extremity amputation

Lin

et al. 2021

Handchir Mikrochir Plast Chir

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Objective To examine the efficacy of three different nerve repair methods for one-stage replantation to treat complete upper extremity amputation and long-term postoperative functional recovery. Methods Twenty-five patients underwent direct nerve anastomosis (Group A), for patients with nerve defects greater than 3 cm, nerve autograft transplantation be used (Group B), or patients with nerve defects less than 3 cm, nerve allograft transplantation be used (Group C) based on the severity of injury. The Disabilities of the Arm, Shoulder, and Hand (DASH) score (higher score means poorer function-less than 25 means good effect) and visual analogue scale (VAS) scores for pain at rest and under exertion were measured. Sensation recovery time and grip function were recorded. Results The mean follow-up time was 78 ± 29 months. Group A had the lowest DASH score, while Group C had the highest DASH score. DASH score differed significantly between the three groups (P < 0.001). Sensation was not restored in two patients in Group B and two patients in Group C, and there were significant between-group differences in sensation recovery (P = 0.001). Group C had the lowest VAS score, while Group A had the highest, and there were significant differences between groups (P = 0.044). Only one patient in Group C recovered grip function. Conclusion Direct nerve anastomosis should be performed whenever possible in replantation surgery for complete upper extremity amputation, as the nerve function recovery after direct nerve anastomosis is better than that after nerve autograft transplantation or nerve allograft transplantation. Two-stage nerve autograft transplantation can be performed in patients who do not achieve functional recovery long after nerve allograft transplantation.

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Section: Discussionmentioning

confidence: 99%

Long-term follow-up of three different nerve repair strategies (repair, autografting and allografting) in one-stage replantation to treat upper extremity amputation

Lin

et al. 2021

Handchir Mikrochir Plast Chir

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“…The authors experience with one previous procedure was highly successful with gratifying results. 2 Logically, the higher the level of transplantation, the poorer is the functional result due to limited motor reinnervation. This is especially true in transhumeral transplantations as, there are higher chances of rejection due to high antigenic load.…”

Section: Discussionmentioning

confidence: 99%

“…1 This is our second experience with the procedure following one successful reconstructive upper limb transplant at proximal forearm level. 2 Above elbow amputations have classically not been considered an ideal candidate for transplantation due to the concerns of graft versus host disease (GVHD) due to the amount of bone marrow transplanted, the quality of nerve regeneration and inadequate regeneration of hand function. 3 In this case, considering the profound impairment in the quality of life of an above-elbow amputee and success results in reimplantations at this level, the procedure was considered.…”

Section: Introductionmentioning

confidence: 99%

Cadaveric Bilateral Transhumeral Upper Limb Transplantation: Journey to the Next level

Dinesh

Aggarwal

Chittoria

et al. 2020

Indian J Plast Surg

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Organ transplant has, arguably, been the pinnacle of the advancement in medical science so far and vascularized composite allotransplantation has been the most recent addition to it. The scope of vascularized tissue allotransplantation has been widening with each passing day and more and more reports regarding the safety and efficacy of the procedure have been described.Due to the limited available literature on the management of the complications and implications of the hand transplant, the importance of each report on the procedure is paramount.A mid-arm allotransplant is a challenge in terms of expected motor recovery, and many controversies exist over the efficacy of the procedure altogether. Moreover, our case was complicated by a long ischemia time due to logistic reasons.We share our experience of a transhumeral upper limb allotransplantation, the complications associated with it along with the early postoperative results at 10 months follow up.

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Infectious complications of vascularized composite allograft transplantation

Steinbrink

Wolfe

2020

Current Opinion in Organ Transplantation

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Purpose of review Vascularized composite allograft (VCA) transplants constitute multiple tissues transplanted together as one functional unit. These procedures are increasing in frequency and complexity, yet data about graft survival, quality of life, and infection risk remain limited. Recent findings Informative guidance for this patient population is often inferred from the solid organ transplantation literature. Yet, it is important to understand that VCA transplantation additionally carries its own significant and distinctive risk factors for infection. Summary In this review, we give an overview of previously described infectious complications of VCA transplantation in the literature, discuss risk factors for future infection in these patients, and discuss how to manage such obstacles.

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Cadaveric Bilateral Proximal Forearm Allotransplantation

Cited by 6 publications

References 4 publications

Long-term follow-up of three different nerve repair strategies (repair, autografting and allografting) in one-stage replantation to treat upper extremity amputation

Long-term follow-up of three different nerve repair strategies (repair, autografting and allografting) in one-stage replantation to treat upper extremity amputation

Cadaveric Bilateral Transhumeral Upper Limb Transplantation: Journey to the Next level

Infectious complications of vascularized composite allograft transplantation

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