title: The role of imaging in patient selection, preoperative planning, and postoperative monitoring in human upper extremity allotransplantation.
abstract: Objective. To describe the role of imaging in vascular composite allotransplantation based on one institution's experience with upper extremity allotransplant patients. Methods. The institutional review board approved this review of HIPAA-compliant patient data without the need for individual consent. A retrospective review was performed of imaging from 2008 to 2011 on individuals undergoing upper extremity transplantation. This demonstrated that, of the 19 patients initially considered, 5 patients with a mean age of 37 underwent transplantation. Reports were correlated clinically to delineate which preoperative factors lead to patient selection versus disqualification and what concerns dictated postoperative imaging. Findings were subdivided into musculoskeletal and vascular imaging criterion. Results. Within the screening phase, musculoskeletal exclusion criterion included severe shoulder arthropathy, poor native bone integrity, and marked muscular atrophy. Vascular exclusion criterion included loss of sufficient arterial or venous supply and significant distortion of the native vascular architecture. Postoperative imaging was used to document healing and hardware integrity. Postsurgical angiography and ultrasound were used to monitor for endothelial proliferation or thrombosis as signs of rejection and vascular complication. Conclusion. Multimodality imaging is an integral component of vascular composite allotransplantation surgical planning and surveillance to maximize returning form and functionality while minimizing possible complications.
authors.affiliation: Department of Diagnostic Radiology, University of Pittsburgh Medical Center (UPMC), C/o Patricia O'Kelly, 200 Lothrop Street Presbyterian South Tower Suite 3950, Pittsburgh, PA 15213, USA.
authors.forename: Eira S
authors.initials: ES
authors.lastname: Roth
authors.affiliation: Department of Interventional Radiology, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA 14224, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Buck
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street Scaife Hall, Suite 678, Pittsburgh, PA 15261, USA.
authors.forename: Vijay S
authors.initials: VS
authors.lastname: Gorantla
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street Scaife Hall, Suite 678, Pittsburgh, PA 15261, USA.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street Scaife Hall, Suite 678, Pittsburgh, PA 15261, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Foust
authors.affiliation: Department of Diagnostic Radiology, University of Pittsburgh Medical Center (UPMC), C/o Patricia O'Kelly, 200 Lothrop Street Presbyterian South Tower Suite 3950, Pittsburgh, PA 15213, USA.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Britton