Unilateral hand transplant-results after 41 months.

We present the final results achieved by a young male hand transplant (HTx) recipient. Harvested from a woman. The limb was grafted at the wrist level 7 years postaccident. There were three HLA-A, -B, -DR mismatches and negative T- and B-cell crossmatches. The maintenance immunosuppression consisted of tacrolimus (trough level 10 ng/mL), steroids (5 mg/d), and mycophenolate mofetil (2 g/d). At the 41-months posttransplant follow-up the Semmens-Weinstein's monofilament tests gave positive results for both main hand nerves: ulnar nerve-blue, median-purple, which rated at S3- and S3+, respectively. The grip strength was 5.4 kg. HTx-specific evaluation systems showed the following results: Hand Transplant Score System (HTSS) 93.5; Chen grade I; Tamai score modified by Ipsen 86; DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire 65. Overall, the patient is able to perform with his transplanted hand practically all daily activities, even those requiring a combination of mobility, motor function, and sensation. He works full-time as a cart driver.

Unilateral arm transplant 28 years after amputation: fourteen-month result.

Hand transplantation now represents a therapeutic alternative for amputees. Arm transplantation poses a serious challenge regarding many respects of the reconstructive procedure. To the end of 2010, only seven such procedures had been performed in four patients. The goal of this article was to present the preliminary results of an arm transplant in a 30-year-old male patient at 14 months. The patient sustained an amputation at the elbow-joint level as a 2-year-old child. The procedure was performed in October 2010. His postoperative course was complicated by one rejection episode (BANFF grade II), and a de novo cytomegalovirus infection. At this early stage, the patient is doing well regaining function. He can flex at the elbow joint, move his fingers, and experience protective sensitivity reaching the palm. The patient is satisfied with his transplantation.

[Intramedullary fixation within bones of the hand: 20 years of experience]. / Szynowanie sródszpikowe kosci reki--20 lat doswiadczen.

Intramedullary fixation within bones of the hand has been used for treatment of 313 fractures in 169 patients after serious trauma or replantation between 1978 and 1998. Kirschner wires or Steinmann pins were introduced at the fracture site and anchored within both metaphyses. The method was used in various types of fractures, comminuted ones and bone defects included. In all cases fracture healed between 4 and 8 weeks. No deep infection occurred, in 2 patients the implants had to be removed because of their migration. The method is technically undemanding and allows for immediate postoperative rehabilitation. Total range of motion exceeded by 15% results achieved in patients treated with temporary immobilization of the hand.

[Tests for evaluating various methods of bone fixation in digital replantation]. / Próba oceny róznych metod zespolenia kostnego replantowanych palców.

Clinical results comparing different methods of bony fixation in 50 replanted digits in a series of 41 patients over a 13 year period are presented. The analysis was restricted only to replantantions involving sharp amputations of the proximal phalanx in order to restrict this study to a relatively homogenous group of patients. Evaluated techniques included: single and crossed Kirschner wire, intraosseous wire with or without Kirschner wire support, intramedullary splintage and intramedullary screws. Angulation deformities and delayed union were most common in cases treated with Kirschner wire technique. Nonunion was noted in 1 case (2%) stabilized with a single Kirschner wire. Angulation deformities were noted in 6 cases (12%). No such complications were noted in cases treated with intramedullary splintage and intramedullary screws. The best stabilizing effect and the most rapid union was noted in cases treated with intramedullary screws.

[Salvage surgery for severely mutilated hand: report of 2 cases]. / Oszczedzajace operacje w przypadkach rozleglych obrazen reki--opis dwóch przypadków.

Immediate, one stage reconstruction is an optimal mode of treatment for severely mutilated hand. This might be feasible only with the use of tissues destined for amputation. Two cases are reported. The first patient had a thumb reconstruction with transfer of the index finger. The second one had metacarpal reconstruction with little finger structures. Both patients resumed previous occupation.