Bilateral hand transplantation: bone healing under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Bone healing after hand transplantation under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone is identical to that after forearm replantation.
Gabl
Markus
M
Department of Traumatology, Leopold Franzens University, Innsbruck, Austria.
Pechlaner
S
S
Lutz
M
M
Bodner
G
G
Piza
H
H
Margreiter
R
R
D000673:Amputation, Traumatic / Q000000981:diagnostic imaging / Q000276:immunology / Q000601:surgery; D001753:Blast Injuries / Q000000981:diagnostic imaging / Q000276:immunology / Q000601:surgery*; D001861:Bone Regeneration / Q000187:drug effects; D002146:Bony Callus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects / Q000276:immunology; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005543:Forearm Injuries / Q000000981:diagnostic imaging / Q000276:immunology / Q000601:surgery*; D017102:Fracture Healing / Q000187:drug effects*; D006225:Hand / Q000098:blood supply; D006230:Hand Injuries / Q000000981:diagnostic imaging / Q000276:immunology / Q000601:surgery*; D063987:Hand Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D018919:Neovascularization, Physiologic / Q000187:drug effects; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D012092:Replantation; D013524:Surgical Flaps / Q000098:blood supply; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D018608:Ultrasonography, Doppler
D007166:Immunosuppressive Agents; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus