Iglesias M, Butrón P, Alberú-Gómez J, Leal P, Jáuregui L, Zamudio J, Santander S, Ricaño D, Bravo RL, Rodríguez E, Cervantes R

Language: Spanish
References: 18
Page: 133-138
PDF size: 226.52 Kb.

ABSTRACT

Upper extremity (UE) transplantation is called composite vascularized allograft. They are considered an emerging surgical reconstruction of the UE. Even when they are in clinical experimental stage, these have proven to offer better quality of life for patients and allowing them to be independent. Up to 2012, 51 patients underwent hand transplantation or UE transplantation. Thirty of them were unilateral and 21 were bilateral. However, rare are the cases transplanted at proximal forearm or arm. The main reason is the prolonged nerve regeneration. We describe the first successful proximal forearm transplant performed in Mexico. This is a 52-year-old male, who suffered amputation of both UE, at level of the proximal third of the forearm as a result of an electrical burn. The transplant was performed on May 18, 2012. Induction treatment was with anti-thymocyte globulin at a dosage of 1.5 mg/kg/day for 5 days. The maintenance immunosuppressive treatment is with prednisone, tacrolimus and mycophenolate mofetil. Four months after transplantation, he began with the mobility of the extrinsic muscles and at eleven months with the mobility of the intrinsic muscles. Also at 11 months post-transplant, he has heat-cold discrimination in both hands. Currently the patient can eat prepared food, bathe, get dressed with difficulty, brush his teeth and write. The end result should be evaluated in the third year post-transplant.

REFERENCES

1. Tintle SM, Baechler MF, Nanos GP 3rd, Forsberg JA, Potter BK. Traumatic and trauma-related amputations: Part II: Upper extremity and future directions. J Bone Joint Surg Am. 2010; 92: 2934-2945.

2. The DASH outcome measure. [Internet]. Mayo, 2013. Disponible en: http://www.dash.iwh.on.ca/system/files/quickdash_questionaire_2010.pdf

3. Gayoso OM. Consecuencias Psicológicas de las Amputaciones. [Internet]. Madrid: Universidad Rey Juan Carlos; 2013. Disponible en: http://www.discapacidadonline.com/wpcontent/uploads/2012/01/consecuencias-psicologicas-amputacion.pdf

4. Toombs, K. What does it mean to be “somebody”? Phenomenological reflections and ethical quandaries. En: Cherry MJ (ed.) Persons and their bodies: rights, responsibilities, relationships. Dordrech: Kluwer Academic Publishers; 1999. pp. 73-94.

5. World Experience Hand Transplantation. [Internet]. Mayo, 2013. Disponible en: http://www.handregistry.com/page.asp?page=4

6. Petruzzo P, Lanzetta M, Dubernard JM. The International Registry on Hand and Composite Tissue Transplantation. Transplantation. 2010; 90: 1590–1594.

7. Comunicación personal del Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 2010.

8. Landin L, Bonastre J, Casado-Sánchez C, et al. Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review. Transplantantion. 2012; 25: 424–432.

9. The Department of Health and Human Services, USA. Organ procurement and transplantation network. Federal Register. 2011; 76: 78216-78224.

10. Edrich T, Cywinsky JB, Colomina MJ. Perioperative management of face transplantation: a survey. Anesth Analg. 2012; 115: 668-670.

11. Schneeberger S, Ninkovic M, Gablb M, Ninkovicc M, Hussld H, Riegere M, et al. First forearm transplantation: outcome at 3 years. Am J Transplantation. 2007; 7: 1753–1762.

12. Capítulo VI Salud en el Trabajo-IMSS. [Internet]. Mayo, 2013. Disponible en : www.imss.gob.mx/estadisticas/financieras/.../2011/06_SaludTrabajo.xls

13. Salinas S, Lozada ME, Rodríguez T, et al. Las lesiones por riesgo de trabajo en el Instituto Mexicano del Seguro Social. Coordinación de Salud del Trabajo, área riesgos de trabajo. IMSS. 1992-1996. Disponible en: www.cofemermir.gob.mx/.../12790.66.59.1.

14. Iglesias M, Butron P, Santander S, et al. Programa de alotrasplante de extremidad superior en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Cir Plast. 2009; 19: 85-92.

15. Cavadas PC, Ibañez J, Thione A, Alfaro L. Bilateral trans-humeral arm transplantation: result at 2 years. Am J Transpl. 2011; 11: 1085-90.

16. Özkan Ö, Demirkan F, Dinckan A, et al. First double hand transplantation in Turkey. J Trans Proceed. 2011; 43: 3557-3560.

17. Petruzzo P, Badet L, Gazarian A, Lanzetta M, Parmentier H, Kanitakis J, et al. Bilateral hand transplantation: six years after the first case. American Journal of Transplantation. 2006; 6: 1718-1724.

18. Schneeberger S, Gorantla VS, Brandacher G, et al. Upper-extremity transplantation using a cell-based protocol to minimize immunosuppression. Ann Surg. 2013; 257: 345-351.