title: Bilateral Forearm Transplantation in Mexico: 2-Year Outcomes.
abstract: BACKGROUND
  Patients with proximal forearm and arm transplantation have obtained and/or maintained function of the elbow joint and full active range of motion of the extrinsic muscles of the hand, but with diminished protective sensibility and a lack of good function of the intrinsic muscles. These patients have improved function, as measured by the Disabilities of the Arm, Shoulder and Hand questionnaire.
  
  
  METHODS
  We report the case of a 52-year-old man who suffered a high-voltage electrical burn requiring amputation of his upper limbs. He underwent bilateral proximal forearm transplantation in Mexico City in May 2012.
  
  
  RESULTS
  At 2-year follow-up, immunosuppressive treatment has not led to metabolic, oncologic, or infectious complications. Keloid scars developed at the graft-recipient interface. There have been 4 acute rejections: the fourth was treated with methylprednisolone, rituximab, and immunoglobulin. Chronic rejection has not been detected. The extrinsic muscles of the wrist and digits have good function. Although the intrinsic muscles demonstrated electrical activity 15 months postoperatively, clinically, they are nonuseful. After 2 years, hand function is sufficient to allow the patient to grasp lightweight and medium-sized objects. The patient's Disabilities of the Arm, Shoulder and Hand questionnaire score improved from 50.00 points to 30.83 points, and his Hand Transplantation Score System rating is good, at 69/73 (right/left) of 100. The patient and his family are very satisfied with the functional and aesthetic outcomes.
  
  
  CONCLUSIONS
  Upper arm or proximal forearm transplantation is a reconstructive option for patients who have experienced amputation because of trauma.
authors.affiliation: 1 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico. 2 Secretaría de Salud del Distrito Federal, Mexico City, Mexico. 3 Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico. 4 Hospital Angeles Mocel, Mexico City, Mexico. 5 Physical Medicine and Rehabilitation, Mexico City, Mexico.
authors.forename: Martin
authors.initials: M
authors.lastname: Iglesias
authors.forename: Patricia
authors.initials: P
authors.lastname: Butron
authors.forename: Mario
authors.initials: M
authors.lastname: Moran-Romero
authors.forename: Angel
authors.initials: A
authors.lastname: Cruz-Reyes
authors.forename: Josefina
authors.initials: J
authors.lastname: Alberu-Gomez
authors.forename: Paulino
authors.initials: P
authors.lastname: Leal-Villalpando
authors.forename: Jorge
authors.initials: J
authors.lastname: Bautista-Zamudio
authors.forename: Maria
authors.initials: M
authors.lastname: Ramirez-Berumen
authors.forename: Euridice
authors.initials: E
authors.lastname: Lara-Hinojosa
authors.forename: Veronica
authors.initials: V
authors.lastname: Espinosa-Cruz
authors.forename: Rocio
authors.initials: R
authors.lastname: Gaytan-Cervantes
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bravo-Ruiz
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rodriguez-Rojas
authors.forename: Jaime
authors.initials: J
authors.lastname: Ramos-Peek
authors.forename: Miriam
authors.initials: M
authors.lastname: Garcia-Alvarez
authors.forename: Felipe
authors.initials: F
authors.lastname: Vega-Boada
authors.forename: Juan
authors.initials: J
authors.lastname: Sierra-Madero
authors.forename: Armando
authors.initials: A
authors.lastname: Gamboa-Dominguez
authors.forename: Judith
authors.initials: J
authors.lastname: Gonzalez-Sanchez
authors.forename: Sarai
authors.initials: S
authors.lastname: Contreras-Barbosa
authors.forename: Africa
authors.initials: A
authors.lastname: Navarro-Lara
authors.forename: Jorge
authors.initials: J
authors.lastname: Vazquez-Lamadrid
authors.forename: Juan
authors.initials: J
authors.lastname: Guzman-Gonzalez
mesh_terms: D000208:Acute Disease; D000671:Amputation, Surgical; D001696:Biomechanical Phenomena; D001706:Biopsy; D002058:Burns, Electric / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004185:Disability Evaluation; D005542:Forearm / Q000294:innervation / Q000601:surgery*; D005543:Forearm Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008800:Mexico; D008875:Middle Aged; D015166:Monitoring, Immunologic; D016377:Organ Transplantation / Q000379:methods* / Q000534:rehabilitation; D017060:Patient Satisfaction; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents