Surgical Technique in Cadaveric Donors for Partial Hand Allotransplant in Patients With Rheumatoid Arthritis

• Published in: Transplantation proceedings 2010-07, Vol.42 (6), p.2389-2394
• Main Authors: Iglesias, M, Butrón, P, Santander-Flores, S, Ricaño-Enciso, D, Negrete-Najar, J.P, Pérez-Monzó, M.F, González-Chávez, A, González-Chávez, M, de Rienzo-Madero, B, Hamdan-Pérez, N
• Format: Article
• Language: English
• Subjects: Arthritis, Rheumatoid - complications; Biological and medical sciences; Cadaver; Diseases of the osteoarticular system; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hand - blood supply; Hand - innervation; Hand Deformities, Acquired - etiology; Hand Deformities, Acquired - surgery; Hand Transplantation; Humans; Inflammatory joint diseases; Medical sciences; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Tissue Donors; Tissue, organ and graft immunology; Transplantation, Homologous - methods
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.05.001

Abstract For patients with severe hand deformities due to rheumatoid arthritis, we propose an allotransplantation of an osteomyotendinose structure (OMTS), preserving the recipient's skin and sensory nerves. Our objective was to develop the surgical technique in a 10 cadavers, five as donors and five as recipients. The donor's hand was 10% to 15% smaller than the recipient's. Dissections were performed by two surgical teams under magnification. In the donor, the OMTS was procured at the distal third of the forearm, maintaining the integrity of the arterial system, with its concomitant veins and motor branches of the median and ulnar nerves, leaving the skin envelope. In the recipient, the OMTS was removed, taking care to preserve the cutaneous cover with the digital arteries in continuity with the superficial palmar arch and radial and ulnar arteries. Also, the digital nerves were maintained in the skin flap, in continuity with the median and ulnar nerves. Their motor branches were divided after emergence from the main nerves. The superficial dorsal veins and radial nerve were kept adhered to the cutaneous cover. Then, the donor OMTS was placed within the recipient cutaneous flap; all the anatomic structures were repaired. The average surgical time was 780 minutes. Methylene blue was present in the digital arteries. There were no difficulties in the anatomic repair. The surgical technique is quite laborious, especially the dissection of the recipient interdigital spaces. Due to the requirement for arterial system integrity, the cutaneous flap must be viable. Also, the allotransplanted OMTS has all necessary conditions to obtain good tissue perfusion for subsequent function. Procurement without skin permits a greater opportunity to find donors, and greater social and personal acceptance by the recipient.