Bilateral Forearm Transplantation in Mexico: 2-Year Outcomes

Area of Science:

• Reconstructive surgery
• Transplantation immunology
• Limb reconstruction

Background:

• Patients undergoing proximal forearm and arm transplantation achieve elbow function and extrinsic hand muscle range of motion.
• However, these patients experience diminished protective sensation and poor intrinsic muscle function.
• Functional outcomes, assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, show improvement.

Observation:

• A 52-year-old male with high-voltage electrical burns underwent bilateral proximal forearm transplantation.
• Follow-up at 2 years revealed no immunosuppression-related complications (metabolic, oncologic, infectious).
• Keloid scarring occurred at the graft interface, with four acute rejections managed effectively; no chronic rejection was observed.

Findings:

• Good function of extrinsic wrist and digit muscles was noted.
• Intrinsic muscles showed electrical activity but lacked clinical utility 15 months post-surgery.
• Hand function allowed grasping of light to medium objects, with a significant DASH score improvement from 50.00 to 30.83.
• The patient achieved a high Hand Transplantation Score System rating (69/73).

Implications:

• Proximal forearm transplantation offers a viable reconstructive solution for traumatic upper limb amputations.
• Despite functional gains, intrinsic muscle recovery remains a limitation.
• Patient and family satisfaction with functional and aesthetic results highlights the procedure's potential benefits.