CC BY-NC-ND 4.0 · Indian J Plast Surg 2019; 52(03): 277-284
DOI: 10.1055/s-0039-3401474
Original Article
Association of Plastic Surgeons of India

Indian Subcontinent’s First Proximal Forearm Level Double Upper Extremity Transplantation

Mohit Sharma
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Subramania Iyer
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Kishore Purushottaman
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Sundeep Vijayaraghavan
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Jimmy Matthew
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Raghuveer Reddy Dudipala
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Janarthanan Ramu
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Jerry Paul
2   Department of Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Sunil Rajan
2   Department of Anaesthesiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Anwar, Meera, Dhruvan, Arun, Arjun,
Vishak Verma
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Ashish Chaudary
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Swapnil Dhake
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Akshay Omkumar
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Radhika Kapahtia
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Dimpy Sharma
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
,
Nirav Maharaja
1   Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
› Author Affiliations
Further Information

Publication History

Publication Date:
26 December 2019 (online)

Abstract

Introduction Vascularized composite allotransplantation (VCA) has added another step to the reconstructive ladder, leading to a paradigm shift in the approach toward management of cases of upper limb amputations. In this article, we discuss in detail the technical aspects of proximal forearm level transplantation, as well as the immediate posttransplant monitoring and immunosuppression protocols.

Materials and Methods A 24-year-old male victim of an electric injury presented with a bilateral proximal forearm level amputation. After the mandatory preoperative psychiatric and immunological evaluation, the patient underwent a proximal forearm level double upper extremity transplantation. He was then put on a stringent immunosuppression and physical rehabilitative regime.

Discussion Conceptually, the proximal forearm level transplantation is significantly different from distal forearm level transplant. This transplant “reestablishes” the “donor extremity length,” maintains the normal functional length of the donor muscles, and the functional return happens only after the newly transplanted donor muscles are reinnervated over a period of time.

Conclusion As the sequence of surgical repair and associated decision making could be quite confusing for this level of transplantation, it is highly advisable to do mock cadaver surgical dissections in order to standardize the procedure and make the team familiar with it.

 
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