raffinose and Forearm-Injuries

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

We report our results using University of Wisconsin (UW) cold storage solution in two cases of major replantation of the upper extremity. We employed a technique of a complete vascular washout with 1000 ml UW solution at 4 degrees Celsius at 120 cm hydrostatic pressure into the artery via a size 18 cannula. The ischaemic time of the amputated limbs were 7 hours and 11 1/4 hours respectively. No fasciotomy was performed upon revascularisation and minimal swelling was observed postoperatively. No post-ischaemic syndrome was encountered following the replantation surgery. With a follow-up of 10 and 16 months respectively, muscle and nerve viability were observed with sensory recovery and motor reinnervation. There was absence of muscle contracture and at subsequent surgical procedures, healthy musculature was present in the replanted limbs. These two clinical cases suggest that the UW solution has a role in extending the duration of tissue preservation and improving the quality of the tissues preserved.

Topics: Adenosine; Allopurinol; Amputation, Traumatic; Anastomosis, Surgical; Arm Injuries; Crush Syndrome; Cryopreservation; Debridement; Follow-Up Studies; Forearm Injuries; Glutathione; Humans; Insulin; Male; Motor Neurons; Nerve Regeneration; Organ Preservation Solutions; Postoperative Complications; Raffinose; Replantation; Wound Healing