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Replantation of Cryopreserved Fingers: An "Organ Banking" Breakthrough
Zengtao Wang1, Lei Zhu1, Wei Kou1
1From the Department of Hand and Foot Surgery, Provincial Hospital Affiliated with Shandong University; Department of Hand and Foot Surgery, Qilu Hospital of Shandong University; Department of Plastic Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University; Department of Orthopedics, The Third Affiliated Hospital of Sun Yat-sen University; Departments of Orthopedics and Plastic Surgery, The First Affiliated Hospital of Sun Yat-sen University; Core Lab, Provincial Hospital Affiliated with Shandong University; National Health and Family Planning Commission of the People's Republic of China; Department of Hand Surgery, Second Affiliated Hospital of Shandong University; and Department of Hand and Foot Surgery, Jinan Traditional Chinese Medicine Hospital Affiliated to Shandong University of Traditional Chinese Medicine.
Background:
Although cryopreservation has been widely used in clinical practice, it remains limited to small or thin bloodless tissues with a simple structure and function. In August of 2002, the authors performed the first successful transplantation of a cryopreserved vascularized rat hind limb. Subsequently, the authors extended this cryopreservation technique to the preservation of human fingers.
Methods:
In December of 2002 and December of 2003, the authors performed two in situ implantations of cryopreserved amputated fingers for two patients by means of the "two-step" and programmed cryopreservation methods. In case 1, computed tomographic angiography was performed on the affected hand 6 months after surgery. In case 2, pieces of skin were obtained from the thawed amputated finger for pathologic examination before replantation.
Results:
One finger was cryopreserved for 81 days and the other for 5 days. Both fingers were replanted successfully. Computed tomographic angiography revealed a patent radial proper digital artery in case 1. The pathologic results of case 2 showed satisfactory skin cell morphology. After 15- and 14-year follow-up assessments of the two patients, the replanted fingers achieved satisfactory appearance and function.
Conclusions:
The authors confirmed the effectiveness of deep cryopreservation for the long-term preservation of human fingers. The current application scope of these cryopreservation techniques includes small limbs with minimal amounts of muscle tissue.
Clinical Question/Level Of Evidence:
Therapeutic, V.