title: Hand transplant - outcome after 6 months, preliminary report.
abstract: BACKGROUND
  Hand transplant still remains a partly experimental procedure because of the small number of patients and short follow-up (not longer than 10 years). Most hand transplantations have been performed at the distal forearm level.
  
  
  METHODS
  The transplant recipient was a 29-year-old man who had lost his dominant right hand 3 years before in a milling machine accident; the donor was a 52-year-old woman. The procurement and transport of the limb were performed according to standard procedures. Preparation of the donor limb and the patient's stump was performed simultaneously by two surgical teams. Anastomoses were done in the following order : bones-tendons-nerves-veins-artery. The radial artery and 3 large veins were anastomosed. The operative wound was closed without a skin graft. Ischemia time was 9 hours. Pharmacological treatment was similar to that usually administered to replantation patients; immunotherapy consisted of Simulect, Prograf, Cell-Cept, and steroids. Physiotherapy was started on the second postoperative day; it consisted of early protective active motion (EPM), continuous passive motion (CPM), splinting, and sensory stimulation. The function of internal organs was monitored; the early outcome was evaluated at 6 months after the transplantation.
  
  
  RESULTS
  The function of internal organs remained undisturbed, no rejection episodes were observed. Bony union was achieved after 11 weeks and progressed steadily, as did the range of motion and reinnervation. On the day of the preliminary assessment, the active range of motion was 200 degrees , 2PD exceeded 15 mm, and electromyography demonstrated temperature sensation and hypothenar muscle function. Functional assessment according to the DASH questionnaire was rated at 67 points, and a quality of life evaluation with the SF-36 questionnaire produced a score of 110 points.
  
  
  CONCLUSIONS
  The distal third of the forearm is a replantation zone promoting early functional recovery.
authors.affiliation: General Surgery Department, Limb Replantation Ward, St Hedwig of Silesia Hospital, Trzebnica. jerzy.jablecki@interia.pl
authors.forename: Jerzy
authors.initials: J
authors.lastname: Jabłecki
authors.forename: Leszek
authors.initials: L
authors.lastname: Kaczmarzyk
authors.forename: Adam
authors.initials: A
authors.lastname: Domanasiewicz
authors.forename: Adam
authors.initials: A
authors.lastname: Chełmoński
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczmarzyk
authors.forename: Maciej
authors.initials: M
authors.lastname: Paruzel
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000534:rehabilitation / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery*; D063987:Hand Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D014184:Transplantation, Homologous; D016896:Treatment Outcome