mycophenolic-acid and Amputation--Traumatic

Little is known about bone healing after composite tissue transplantation that requires pharmacologic immunosuppression. Bone integration and callus development were assessed in bilateral hand transplantation.. In this study the course of callus development and callus maturation were assessed by color Doppler sonography and radiography in a double hand transplant and compared with forearm replantation.. After hand transplantation, ingrowth of small vessels at the bone junction was observed at week 3, calcified callus became visible at month 4, and bone union was completed at month 11. A similar time course of bone integration was observed after replantation. Plating offered sufficient stability. A recipient periostal flap is thought to have improved blood supply and favored development and induction of callus.. Bone healing after hand transplantation under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone is identical to that after forearm replantation.

Topics: Amputation, Traumatic; Blast Injuries; Bone Regeneration; Bony Callus; Drug Therapy, Combination; Follow-Up Studies; Forearm Injuries; Fracture Healing; Hand; Hand Injuries; Hand Transplantation; Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Neovascularization, Physiologic; Prednisolone; Replantation; Surgical Flaps; Tacrolimus; Ultrasonography, Doppler

The first hand allograft was performed on September 23, 1998. The right distal forearm and hand of a brain dead donor was transplanted to a 48 year old recipient who had undergone a traumatic amputation of the distal third of his right forearm. The donor's arm was irrigated with organ preservation solution (UW) and transported to Lyon in a cool container. Two teams simultaneously dissected the donor's limb and the recipient's stump to identify anatomical structures. Transplantation involved bone fixation, arterial and venous anastomoses, nerve sutures, joining of the muscles and tendons, and skin closure. Immunosuppression consisted of anti-lymphocyte, polyclonal and monoclonal antibodies, tacrolimus, mycophenolic acid, and prednisone. Mild clinical and histological signs of rejection occurred at week 9 after surgery. They disappeared with adjustments of the immunosuppressant doses. Seven months after surgery the patient was in good general condition. Intensive physiotherapy led to satisfactory progress of motor function. Sensory progress is excellent, reaching the fingertips. A longer follow-up is necessary to appreciate the final result. In the absence of further rejection, the functional prognosis of the graft should be similar to that reported after successful autoreconstruction.

Topics: Adenosine; Allopurinol; Amputation, Traumatic; Anastomosis, Surgical; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antilymphocyte Serum; Arteriovenous Shunt, Surgical; Enzyme Inhibitors; Follow-Up Studies; Forearm Injuries; Glutathione; Graft Rejection; Hand; Hand Transplantation; Humans; Immunosuppressive Agents; Insulin; Internal Fixators; Male; Middle Aged; Muscle, Skeletal; Mycophenolic Acid; Organ Preservation Solutions; Physical Therapy Modalities; Prednisone; Raffinose; Tacrolimus; Tendons; Transplantation, Homologous