UNILATERAL ARM TRANSPLANT 28 YEARS AFTER AMPUTATION – 14 MONTH RESULT

Jerzy Jablecki¹, Leszek Kaczmarzyk¹, Adam Domanasiewicz¹, Adam Chelmonski¹.

¹Department of Replantatrion of Limbs St Jadwiga Hosp, Trzebnica, Poland.

Background: Arm transplants although technically easier than more distal transplants present many challenges, such as : a great muscle mass endangered by ischemia and a long distance between the nerve stump and their end organs negatively influencing the functional result, the last but not least is the time – laps between the amputation and Tx This “waiting – time” was relatively short (few years) in all except our arm -Tx patient In his case it was 28 years.

Case presentation: Our patient is a 30-year-old white male who lost his dominant right upper-limb (on the level of elbow joint) in an accident with a harvester when he was 2 years old What is exceptional in him is that he does not remember himself as non-invalid He runs a small computer firm, wore a cosmetic prosthesis for 22 years before receiving his new hand. The transplant was performed in October 2009. Donor was a brain-dead 51 year old female There were 4 HLA miss-matches. The recipient’s muscles were atrophic, so the anastomosis was performed “en masse”.

Result: The patient is in a very good health condition, has a mild non-insulin dependent glicaemia, he can flex his elbow against gravity (60°), a protective sensation reached his palm, he can flex his fingers (ROM - 50°) ; actively uses the hand in household activities He had one rejection episode that resolved quickly. At this very early stage in the posttransplant course, the patient is doing well and regaining function . Psychosocial evaluation find this patient experiencing great satisfaction and happiness with his transplant.

Conclusion: Long time – span between amputation and Tx does not seem to be a contraindication for an arm Tx.