THE QUADRIMEMBRAL AMPUTEE, INDICATIONS AND CONTRAINDICATIONS FOR HAND TRANSPLANTATION

Lawrence Levin¹, Abtin Foroohar¹, Fei Liu¹

¹Department of Orthopaedic Surgery, University of Pennsylvania, PA, USA.

Quadrimembral amputees are patients’ that have lost all or part of both their upper and lower extremities.

We have retrospectively reviewed 5 quadrimemral amputees that were evaluated by our hands transplants surgeons as candidates for hand transplantation. Patients ranged in age from 21 to 53 (mean 35) years of age (3 females, 2 males). All 5 had bilateral below knee amputations, 4 had bilateral below elbow amputations, and one had bilateral radio-carpal amputations. They presented 2 to 36 (mean 13) months from time of amputations. All patients are completely dependent for all activities of daily living (ADL), are unable to work, and live in special care facilities. All etiologies were based in extremity ischemia: 3 from septic shock, 1 from myocardial infarction and 1 from drug overdose.

Clearance for transplantation is based on medical stability, absence of infection or systemic diseases, and strong psychosocial support systems. 2 patients met these criteria and have been listed for transplantation.

Contraindications for transplantation are drug dependence and noncompliant behavior (1 patient). Relative contra-indications included potential complications with immunosuppression in 2 patients with previous renal or hepatic insufficiency (2 patients).

Quadrimembral amputees face significant challenges and will benefit greatly from hand transplantation. A systemic evaluation of indications and contraindications is described for this subset of hand transplant patients.