Severe Complications After Bilateral Upper Extremity Transplantation

Iglesias, Martin; Leal, Paulino; Butrón, Patricia; Santander-Flores, Selene Artemisa; Ricaño-Enciso, Diego; González-Chávez, Mario Andrés; González-Chávez, Alberto Manuel; Bravo-Ruiz, Leonardo; Leon-Lopez, D.A.; García-Mancilla, Sofía; Díaz-Morales, Melina; Moran-Romero, Mario; Espino-Gaucin, Israel; Rodriguez-Rojas, Elizabeth

doi:10.1097/tp.0000000000000258

Cited by 11 publications

(3 citation statements)

References 4 publications

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“…Social death assessment is applicable for both adult and pediatric patients. To date, there have been only 4 cases of pediatric VCA, 1 lower limb transplant ( 44 ) and 3 upper limb transplants( 45 – 47 ), thus the pediatric data set is very limited. For children and teens, their experiences of social isolation, loneliness, ostracism, personhood, role, and identity will likely be different to those of adults; however, their experiences are still valid to the concept of social death.…”

Section: Discussionmentioning

confidence: 99%

A Lifesaving View of Vascularized Composite Allotransplantation

Bramstedt

2017

Journal of Patient Experience

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Introduction:Most solid organ transplantation is viewed as lifesaving, whereas vascularized composite allotransplantation (VCA) has been viewed as life enhancing. This article challenges the latter and argues that “social death” evident in severe face, hand, and larynx disfigurement can be potentially treated via VCA. Social death (from a social science perspective) consists of a combination of 7 components: social isolation, loneliness, ostracism, loss of personhood, change of role and identity, harm, and disfigurement.Methods:In February 2016, PubMed and Google were searched for case reports of human face, hand, and larynx transplantation. Patient and team narratives were then coded for components of social death using social science and medical model criteria.Results:Eleven narratives were identified among 9 articles. The social science model (but not the medical model) described pretransplant social death and the resolution of social death by receiving VCA. Notably, the medical model of social death was deemed unsuitable for application to VCA. This is because case narratives consistently contradict elements of the medical model.Conclusions:By including social death as a patient inclusion criterion for face, hand, and larynx VCA, these transplants can be considered lifesaving. Additionally, because VCA requires lifelong immunosuppressant medication, considering VCA as a lifesaving intervention improves the technology’s risk–benefit analysis. Guidance for assessing social death is provided.

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Section: Discussionmentioning

confidence: 99%

A Lifesaving View of Vascularized Composite Allotransplantation

Bramstedt

2017

Journal of Patient Experience

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“…In addition, the first face allograft retransplantation has been reported in a patient whose allograft needed to be removed because of necrotizing chronic rejection . In isolated UET, the high overall survival rate is highlighted by only a single patient’s death immediately after the procedure . The other fatalities were encountered in the setting of simultaneous face or lower extremity transplants .…”

Section: Complicationsmentioning

confidence: 99%

Innovations in reconstructive microsurgery: Reconstructive transplantation

Kollar

Tasigiorgos

Dorante

et al. 2018

Journal of Surgical Oncology

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In the past 20 years, reconstructive transplantation (RT) has emerged as a viable reconstructive option for carefully selected patients. More than 100 upper extremity and 40 face transplants have been performed worldwide to date. Concomitantly, the portfolio of reconstructive transplantation has been extended by additional procedures such as lower extremities, abdominal wall, neck, uterus, genitourinary, and pediatric transplants. In the present review article, we aim to summarize the current state of knowledge about this exciting field.

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“…Another factor that limits arm transplantation is the large amount of muscle mass present in the transplant, which demands shorter periods of ischemia and carries the risk of greater complications, including death. 4,5 To the best of our knowledge, only eight arm transplants have been performed in seven patients to date. Of these, one was at the level of the proximal third of the humerus, five were transhumeral, and two were at the distal third of the humerus.…”

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confidence: 99%

Anatomical and Microsurgical Implications in Total and Midarm Transplantation

Iglesias

Salazar-Hernández

Ramírez-Berumen

et al. 2017

J Reconstr Microsurg Open

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Background Arm transplantations are performed less frequently than forearm and hand transplantations. We present the surgical and microsurgical technique and its relationship with the clinical results in a patient with bilateral arm transplantation. Methods A 51-year-old male patient underwent bilateral arm transplantation in October 2015. The right arm was transplanted at the glenohumeral joint. The vascular repair was at the axillary level, and the nerves were repaired at their origin. The total ischemia time was 3 hours and 48 minutes. The left arm was transplanted at the midhumeral level; all muscles were completely transplanted. The nerves were repaired at the distal third of the arm. Additionally, terminolateral neurorrhaphy was performed from the donor musculocutaneous nerve to the recipient radial nerve. The total ischemia time was 6 hours and 35 minutes. Results At 15 months posttransplantation, the right shoulder had an abduction of 90 degrees and muscle strength of M4; flexion of 100 degrees and M4; internal and external rotation of M1; elbow flexion of 120 degrees and M3; elbow extension of M5;

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Severe Complications After Bilateral Upper Extremity Transplantation

Cited by 11 publications

References 4 publications

A Lifesaving View of Vascularized Composite Allotransplantation

A Lifesaving View of Vascularized Composite Allotransplantation

Innovations in reconstructive microsurgery: Reconstructive transplantation

Anatomical and Microsurgical Implications in Total and Midarm Transplantation

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