First successful lower-extremity transplantation: technique and functional result

Area of Science:

• Regenerative Medicine
• Transplant Surgery
• Pediatric Surgery

Background:

• Composite tissue transplantation (CTT) offers an alternative to prosthetics and reconstructive surgery for complex limb defects.
• Previous CTT applications have shown success in the upper extremity and face, but not yet in the lower extremity.
• Ischiopagus twinning presents unique challenges and opportunities for transplantation due to shared vasculature and immune compatibility.

Observation:

• A normal lower limb from a non-surviving 3-month-old ischiopagus twin was transplanted to its healthy twin.
• The transplant was surgically revascularized and reinnervated in the recipient's pelvic region.
• The recipient twin was otherwise healthy, facilitating the transplant procedure.

Findings:

• The transplanted lower limb survived successfully.
• No immunosuppressive therapy was required due to inherent immune compatibility between the twins.
• Encouraging return of muscle function, sensation, and spontaneous cortical control was observed in the transplanted limb.

Implications:

• This case demonstrates the feasibility of lower extremity CTT in infants.
• Immune compatibility in twin transplants eliminates the need for immunosuppression, reducing associated risks.
• The successful functional recovery suggests potential for CTT in treating congenital lower limb anomalies.