Perioperative ischemic injury and fibrotic degeneration of muscle in a forearm allograft: functional follow-up at 32 months post transplantation

Allografts of the forearm are still uncommon in the field of composite tissue allograft transplantation. In November 2007, a right-hand allograft and a left-hand/full-length forearm allograft were transplanted in a 30-year-old man who lost both hands and the vision in his left eye due to an explosio...

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Bibliographic Details
Published inAnnals of plastic surgery Vol. 66; no. 2; p. 202
Main Authors Landin, Luis, Cavadas, Pedro C, Garcia-Cosmes, Pedro, Thione, Alessandro, Vera-Sempere, Francisco
Format Journal Article
LanguageEnglish
Published United States 01.02.2011
Subjects
Adult
Amputation, Traumatic - surgery
Fibrosis
Follow-Up Studies
Forearm - blood supply
Forearm - pathology
Forearm - surgery
Hand - blood supply
Hand - pathology
Hand Injuries - surgery
Hand Transplantation
Humans
Ischemia - complications
Ischemia - etiology
Male
Postoperative Complications - etiology
Recovery of Function
Time Factors
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Summary:Allografts of the forearm are still uncommon in the field of composite tissue allograft transplantation. In November 2007, a right-hand allograft and a left-hand/full-length forearm allograft were transplanted in a 30-year-old man who lost both hands and the vision in his left eye due to an explosion. The patient underwent alemtuzumab and steroid induction therapy. Tacrolimus, mycophenolate mofetil, and low doses of steroids were given to prevent rejection. The allografts were rejected 3 times, but these episodes were controlled successfully. The immunosuppressive regimen was switched from tacrolimus to sirolimus because of increased serum creatinine. The left allograft showed a flexion contracture due to muscle fibrosis that was conjectured to be associated with a perioperative ischemic injury and permitted only a Moberg-type key pinch. In contrast, an excellent grade of function was observed in the right allograft. The Disabilities of the Shoulder, Arm, and Hand score improved from 70.83 to 36.6 and intrinsic musculature returned to both allografts. The patient was able to work 2 years after transplantation. This is the first report of an ischemic injury related to the successful allotransplantation of a composite tissue.
ISSN:1536-3708
DOI:10.1097/SAP.0b013e318206a365