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Updated: May 5, 2026

Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
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Technical implications in proximal forearm transplantation.

Nicholas T Haddock1, Benjamin Chang, David J Bozentka

  • 1Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA.

Techniques in Hand & Upper Extremity Surgery
|December 7, 2013
PubMed
Summary
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Bilateral proximal forearm transplantation offers promising functional recovery for severe upper limb amputations. This complex procedure demonstrates potential for improved independence and prosthesis use in patients with proximal injuries.

Area of Science:

  • Regenerative Medicine
  • Transplantation Surgery
  • Orthopedic Surgery

Background:

  • Vascularized composite allotransplantation (VCA) has advanced over a decade, focusing on hand transplantation for distal amputations.
  • Proximal upper limb amputations present unique challenges requiring distinct surgical approaches for functional restoration.
  • Defining patient selection, indications, and immunologic strategies are crucial for VCA success.

Observation:

  • A single case of bilateral proximal forearm transplantation is presented, detailing unique technical considerations.
  • The surgical procedure was meticulously described for this complex reconstructive challenge.
  • Post-operative assessment at 19 months revealed significant functional recovery.

Findings:

  • The patient achieved 4/5 muscle strength in finger, thumb, and wrist flexors and extensors.

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  • Restoration of sensation was noted in the transplanted forearms.
  • The patient regained independence in daily activities, including the use of lower extremity prostheses.

    • Implications:

    • Forearm transplantation allows transfer of the entire functional unit, optimizing outcomes for proximal amputations.
    • This approach holds significant potential for improving quality of life and functional independence in severely injured patients.
    • Continued improvement is anticipated with longer follow-up, highlighting the promise of VCA in complex limb reconstruction.