Bilateral Proximal Forearm Transplantation: Case Report at 7 Years.

Autor:	Iglesias M; Plastic Surgery Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Villanueva-Castro E; Resident of General Surgery, The American British Cowdray Medical Center, Mexico City, Mexico., Macias-Gallardo J; Laboratory of Clinical Neurophysiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Alberú-Gómez J; Transplant Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Leal-Villalpando RP; Anesthesiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Zamudio-Bautista J; Anesthesiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Acosta V; Anesthesiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Butrón P; Plastic Surgery Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Sierra-Madero JG; Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Cuellar-Rodriguez J; Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Espinosa-Cruz V; Radiology and Imaging Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Gómez-Camargo C; Tomography Service Attendant, CT Scanner San Ángel, Mexico City, Mexico., Mayorquín-Ruiz M; Ocular Ultrasound Service, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico., Vázquez-Lamadrid J; Radiology and Imaging Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico., Toussaint-Caire S; Dermatology Department, Hospital Gea Gonzalez, Secretaria de Salud, Mexico City, Mexico., Domínguez-Cherit J; Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico., Dorantes-García J; Cardiology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico., Furuzawa-Carballeda J; Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico., Hernandez-Castillo CR; CONACYT - Instituto de Neuroetologia, Universidad Veracruzana, Xalapa, Mexico., Guzmán González JM; Physical Medicine and Rehabilitation, México City, México., Castelan-Carmona N; Histocompatibility Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico., López-Mártinez M; Histocompatibility Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico., González-Tableros N; Histocompatibility Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico., Arvizu-Hernández A; Histocompatibility Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico., De Santiago-Zárate A; Histocompatibility Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico.
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2020 Apr; Vol. 104 (4), pp. e90-e97.
DOI:	10.1097/TP.0000000000003083
Abstrakt:	Background: Although return of function has been reported in patients undergoing proximal forearm transplantations (PFTs), reports of long-term function are limited. In this study, we evaluated the clinical progress and function 7 years postoperatively in a patient who underwent bilateral PFT. Case Presentation: A 58-year-old man underwent bilateral PFT in May 2012. Transplantation involved all of the flexor and extensor muscles of the forearm. Neurorrhaphies of the median, ulnar, and radial nerves were epineural and 7 cm proximal to the elbow. Immunosuppressive maintenance medications during the first 3 years postoperatively were tacrolimus, mycophenolate, and steroids, and later, tacrolimus, sirolimus, and steroids. Forearm function was evaluated annually using the Disabilities of the Arm, Shoulder, and Hand; Carroll; Hand Transplantation Score System; Short Form-36; and Kapandji scales. We also evaluated his grip and pinch force. Results: Postoperatively, the patient developed hypertriglyceridemia and systemic hypertension. He experienced 6 acute rejections, and none were resistant to steroids. Motor function findings in his right/left hand were: grip strength: 10/13 kg; key pinch: 3/3 kg; Kapandji score: 6/9 of 10; Carroll score: 66/80; Hand Transplantation Score System score: 90/94. His preoperative Disabilities of the Arm, Shoulder, and Hand score was 50 versus 18, postoperatively; his Short Form-36 score was 90. This function improved in relation with the function reported in the second year. Conclusions: Seven years following PFT, the patient gained limb strength with a functional elbow and wrist, although with diminished digital dexterity and sensation. Based on data presented by other programs and our own experience, PFT is indicated for select patients.
Databáze:	MEDLINE
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