ISCHEMIC INCIDENT DUE TO ARTERIAL THROMBOSIS COMPLICATING POSTOPERATIVE COURSE OF A HAND TRANSPLANT

Adam Domanasiewicz¹, Janusz Kaczmarzyk¹, Leszek Kaczmarzyk¹, Jerzy Jablecki¹.

¹Department of General Surgery, Subdepartment of Limb Replantation, St Hedwig Hospital in Trzebnica, Poland.

Background: The risk of arterial thrombosis due to continuous, invasive blood pressure monitoring is estimated to reach 85%, in particular when an appropriate antithrombotic prophylaxis is contraindicated because of the underlying disease. The injury to the intima inflicted with the catheter does not limit only to the neighboring nor proximal areas - the coagulation initiated by the catheter spreads from it distally and affects the palmar arch.

Case presentation: A 34-y.o. ex-military recipient of a double-hand transplant, suffered from recurrent episodes of clotting within and distally from the vascular anasthomoses requiring during the first 3 postoperative days five vascular revisions, perfusions and thrombembolectomies performed with a thin epidural catheter. As a result the limb circulation was restored. However, the prolonged time of warm ischemia produced massive epidermolysis of the left hand and necrosis of distal phalanges which lead to their amputation. A collagen-matrix glove (Biobrane), previously used for treating burns and epidermolysis bullosa, was applied to the affected hand in order to prevent infection. With the uninterrupted process of rehabilitation epithelialization was achieved within two weeks.

Conclusions: In potential hand donors arterial catheterization of the limb to be harvested should be avoided. Circulation impairment of the transplanted limb calls for an urgent microsurgical action involving revising of the anastomosed vessels as done in case of replantation. Similarities of local lesions in ischemic epidermolysis and burns allows for successful application of biomaterials (such as Biobrane) in the treatment of both conditions.