Anatomical and Microsurgical Implications in Total and Midarm Transplantation

Martin Iglesias; Fernanda Salazar-Hernández; María F. Ramírez-Berumen; Patricia Butrón; Josefina Alberú-Gómez; Rafael P. Leal-Villalpando; Jorge Zamudio-Bautista; Victor Acosta; Luis A. Jauregui-Flores; Verónica Espinosa-Cruz; Jorge Vázquez-Lamadrid; Judith González-Sánchez; Carlos A. Hinojosa; Hugo Laparra-Escareño; Juan Montejo-Vargas; Julio Macias-Gallardo

doi:10.1055/s-0037-1604342

Journal of Reconstructive Microsurgery Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2017; 02(02): e94-e102
DOI: 10.1055/s-0037-1604342

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anatomical and Microsurgical Implications in Total and Midarm Transplantation

Martin Iglesias

¹Department of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Fernanda Salazar-Hernández

¹Department of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

María F. Ramírez-Berumen

¹Department of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Patricia Butrón

¹Department of Plastic Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Josefina Alberú-Gómez

²Department of Transplants, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Rafael P. Leal-Villalpando

³Department of Anesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Jorge Zamudio-Bautista

³Department of Anesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Victor Acosta

³Department of Anesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Luis A. Jauregui-Flores

⁴Department of Anesthesiology, Hospital General Gea Gonzalez, Secretaria de Salud, México

,

Verónica Espinosa-Cruz

⁵Department of Radiology and Imaging, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Jorge Vázquez-Lamadrid

⁵Department of Radiology and Imaging, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Judith González-Sánchez

⁶Department of Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Carlos A. Hinojosa

⁷Department of Vascular Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Hugo Laparra-Escareño

⁷Department of Vascular Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Juan Montejo-Vargas

⁸Department of Orthopedic, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

,

Julio Macias-Gallardo

⁹Laboratory of Clinical Neurophysiology, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” México City, México

› Institutsangaben

Abstract

Background Arm transplantations are performed less frequently than forearm and hand transplantations. We present the surgical and microsurgical technique and its relationship with the clinical results in a patient with bilateral arm transplantation.

Methods A 51-year-old male patient underwent bilateral arm transplantation in October 2015. The right arm was transplanted at the glenohumeral joint. The vascular repair was at the axillary level, and the nerves were repaired at their origin. The total ischemia time was 3 hours and 48 minutes. The left arm was transplanted at the midhumeral level; all muscles were completely transplanted. The nerves were repaired at the distal third of the arm. Additionally, terminolateral neurorrhaphy was performed from the donor musculocutaneous nerve to the recipient radial nerve. The total ischemia time was 6 hours and 35 minutes.

Results At 15 months posttransplantation, the right shoulder had an abduction of 90 degrees and muscle strength of M4; flexion of 100 degrees and M4; internal and external rotation of M1; elbow flexion of 120 degrees and M3; elbow extension of M5; pronosupination of M2; and wrist extension of M2. There was no mobility in the fingers. The left transplanted limb had total elbow flexion and extension of M5, pronosupination of M2, wrist extension of M4, and finger flexion of M2. Both extremities had thermal sensitivity that allowed discrimination of cold and heat with residual deep pressure.

Conclusion Although the functional results of arm transplantation are so far unknown, they may be considered beneficial compared with the devastating disability caused by arm amputation.

Keywords

arm transplantation - vascularized composite allotransplantation - hand transplantation

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Referenzen

References
1 Jones NF, Schneeberger S. Arm transplantation: prospects and visions. Transplant Proc 2009; 41 (02) 476-480
2 Shores JT, Higgins JP, Lee WP. Above-elbow (supracondylar) arm transplantation: clinical considerations and surgical technique. Tech Hand Up Extrem Surg 2013; 17 (04) 221-227
3 Salminger S, Roche AD, Sturma A, Mayer JA, Aszmann OC. Hand transplantation versus hand prosthetics: pros and cons. Curr Surg Rep 2016; 4: 8
4 Iglesias M, Leal P, Butrón P. , et al. Severe complications after bilateral upper extremity transplantation: a case report. Transplantation 2014; 98 (03) e16-e17
5 Messner F, Grahammer J, Hautz T, Brandacher G, Schneeberger S. Ischemia/reperfusion injury in vascularized tissue allotransplantation: tissue damage and clinical relevance. Curr Opin Organ Transplant 2016; 21 (05) 503-509
6 Tuffs A. Munich surgeons perform world's first transplantation of whole arms. BMJ 2008; 337: a1162
7 Cavadas PC, Ibáñez J, Thione A, Alfaro L. Bilateral trans-humeral arm transplantation: result at 2 years. Am J Transplant 2011; 11 (05) 1085-1090
8 Jablecki J, Kaczmarzyk L, Domanasiewicz A. , et al. Result of arm-level upper-limb transplantation in two recipients at 19- and 30-month follow-up. Ann Transplant 2012; 17 (03) 126-132
9 Shores JT, Brandacher G, Lee WP. Hand and upper extremity transplantation: an update of outcomes in the worldwide experience. Plast Reconstr Surg 2015; 135 (02) 351e-360e
10 Chełmoński A, Kowal K, Jabłecki J. The physical and psychosocial benefits of upper-limb transplantation: a case series of 5 polish patients. Ann Transplant 2015; 20: 639-648
11 Ruane ME. Johns Hopkins Hospital performs double arm transplant on Army soldier. The Washington Post. January 28, 2013. Available at: https://www.washingtonpost.com/local/johns-hopkins-hospital-performs-double-arm-transplant-on-army-soldier/2013/01/28/d4b8e082-673c-11e2-93e1-475791032daf_story.html?tid=a_inl&utm_term=.01885c975b6c . Accessed December 8, 2016
12 Hand Transplant History. Composite Tissue Allotransplantation. Available at: http://www.handtransplant.com/TheProcedure/HandTransplantHistory/tabid/96/Default.aspx . Accessed December 8, 2016
13 John Peck, Bilateral Arm Transplant Patient. Brigham and Women's Hospital. Available at: http://www.brighamandwomens.org/About_BWH/publicaffairs/news/HandTransplant/Peck.aspx . Accessed December 8, 2016
14 Schneeberger S, Landin L, Jableki J. , et al; ESOT CTA Working Group. Achievements and challenges in composite tissue allotransplantation. Transpl Int 2011; 24 (08) 760-769
15 Iglesias M, Butrón P, Moran-Romero M. , et al. Bilateral forearm transplantation in Mexico: 2-year outcomes. Transplantation 2016; 100 (01) 233-238
16 Iglesias Morales M, Butrón Gandarillas MP, García Mancilla S. , et al. Descripción de muestra de receptores de extremidad superior. Rev Mex Traspl 2013;2(S1):S26. Available at: http://www.medigraphic.com/pdfs/trasplantes/rmt-2013/rmts131e.pdf
17 Carlsen BT, Al-Mufarrej F, Moran SL. Surgical anatomy of hand allotransplantation. Clin Anat 2013; 26 (05) 578-583
18 Schneeberger S, Ninkovic M, Gabl M. , et al. First forearm transplantation: outcome at 3 years. Am J Transplant 2007; 7 (07) 1753-1762
19 Hartzell TL, Benhaim P, Imbriglia JE. , et al. Surgical and technical aspects of hand transplantation: is it just another replant?. Hand Clin 2011; 27 (04) 521-530 , x
20 McDiarmid SV, Azari KK. Donor-related issues in hand transplantation. Hand Clin 2011; 27 (04) 545-552 , x–xi
21 Azari KK, Imbriglia JE, Goitz RJ. , et al. Technical aspects of the recipient operation in hand transplantation. J Reconstr Microsurg 2012; 28 (01) 27-34
22 Banegas RN, Moreno R, Duggal A, Breidenbach III WC. Surgical aspects of donor hand recovery for transplantation. J Reconstr Microsurg 2012; 28 (01) 21-26
23 Haddock NT, Chang B, Bozentka DJ, Steinberg DR, Levin LS. Technical implications in proximal forearm transplantation. Tech Hand Up Extrem Surg 2013; 17 (04) 228-231
24 Pulos N, Shaked A, Abt PL. , et al. Hand allotransplantation: operating room set-up and team coordination. Tech Hand Up Extrem Surg 2015; 19 (02) 68-72
25 Cetrulo Jr CL, Kovach SJ. Procurement of hand and arm allografts. Tech Hand Up Extrem Surg 2013; 17 (04) 232-238
26 Małecki R, Gacka M, Boratyńska M. , et al. Assessment of vascular function of hand allografts. Ann Transplant 2014; 19: 621-628
27 Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg 2002; 10 (06) 620-630
28 Maier D, Jaeger M, Izadpanah K, Strohm PC, Suedkamp NP. Proximal humeral fracture treatment in adults. J Bone Joint Surg Am 2014; 96 (03) 251-261
29 Rovak JM, Cederna PS, Macionis V, Urbanchek MS, Van Der Meulen JH, Kuzon Jr WM. Termino-lateral neurorrhaphy: the functional axonal anatomy. Microsurgery 2000; 20 (01) 6-14
30 Papalia I, Geuna S, D'Alcontres FS, Tos P. Origin and history of end-to-side neurorrhaphy. Microsurgery 2007; 27 (01) 56-61