Patient rehabilitation following hand transplantation at forearm distal third level

The results of hand transplantations in terms of both graft survival (49/52, i.e. 94.3%) and hand function recovery are very inspiring. The degree of functional recovery is similar to that achieved after hand replantation at the same level. With regard to function recovery, the most favorable level of replantation seems to be the distal third of the forearm, with 75% of hand transplantations performed at this level. The aim of this paper was to present the process of limb rehabilitation following a hand transplantation at the level of the forearm's distal third. The recipient, a 29-year-old male, lost his right dominant hand 6 years before the operation in a drum flaker accident. The donor was a 52-year-old female. The limb was transplanted in a standard manner, with an uneventful postoperative period. The multidirectional rehabilitation focused on motor and sensory function as well as the recipient's psychological status. First passive finger movements were introduced on postoperative day 2, followed by assisted active movements from day 21 post-transplant onwards, and from day 28 we implemented exercises with an outrigger extension splint. Favorable hand position positioning was ensured by changing ortheses frequently. Motor rehabilitation relied on Perfetti's visual-motor training (from d 28 p-op.) together with continuous passive motion (Artromot F device). We also used electrical stimulation of the nerve trunks and intrinsic muscles of the hand as well as discrimination exercises of tactile sensation. The rehabilitation process was very similar to the one we use in patients after limb replantation. We assessed the motor and sensory functions of the grafted limb as very good despite diminished muscle strength, which does not affect the general functional result. The recipient adapted perfectly to living with a transplanted limb. The outcomes achieved by the hand transplant recipient confirm the need of early and multidirectional rehabilitation.