RAPID BONE HEALING IN AN ARM TRANSPLANT PATIENT

Jerzy Jablecki¹, Adam Domanasiewicz¹, Adam Chelmonski¹.

¹Subdep of Replantation of Limbs, St Jadwiga Hosp, Trzebnica, Poland.

Background: Bone healing in hand transplantation (Tx) patients does not evoke so much attention as other aspects of tissue regeneration (soft tissue mostly) The reason for such an attitude may be a small percentage of complications observed within bony union Still there is no consensus among the authors regarding the superiority of bony union progression in hand Tx over that in ordinary bone osteosynthesis and especially in replantation.

Method: A male, 32 years of age was had a mid-arm transplantation on Nov. 2009. He lost his hand as a child 28 years ago Before hand Tx he could easily abduct the arm-stump, it’s humeral bone was 7mm slimmer than the contra lateral one, and generally sclerotic The donor was a brain-dead female, 55 years of age ; the width of the donor’s arm bone at the site of osteosynthesis was 6 mmgreater Due to such an obstacle and priory long time of cold ischemia, a bouquet osteosynthesis by means of a bundle of 7 K-wires was performed Around the site of osteosynthesis small pieces of donor bone (size 3x6 mm on average) were located After the operation the limb was put for 2 months in an arm cast ; the control X-ray proved a 6 mm distension which could not be reduced The wound healed properly, a general course was uneventful except for CMV infection Every 6 weeks control X-ray was taken showing successive unification and filling of the gap.

Result: The bony union was completed after 6 months.

Conclusion: The rapid filling of the gap in the site of the bony anastomosis, despite of an unstable osteosynthesis and short time of immobilization proves a great potential of transplanted limbs for creating a strong bony union.