Bilateral Proximal Forearm Transplantation: Case Report at 7 Years

Area of Science:

• Orthopedic Surgery
• Transplantation Medicine
• Reconstructive Surgery

Background:

• Limited long-term data exists for proximal forearm transplantation (PFT) outcomes.
• This study evaluates 7-year postoperative function after bilateral PFT.

Observation:

• A 58-year-old male underwent bilateral PFT, including forearm flexor/extensor muscles and nerve coaptations.
• The patient received a multi-drug immunosuppression regimen (tacrolimus, mycophenolate/sirolimus, steroids).
• Annual functional assessments included DASH, Carroll, HTSS, SF-36, Kapandji scores, and grip/pinch strength.

Findings:

• The patient achieved significant improvements in grip strength (10/13 kg) and pinch strength (3/3 kg).
• Postoperative DASH score improved from 50 to 18, indicating enhanced upper extremity function.
• Seven years post-PFT, the patient demonstrated functional elbow and wrist mobility, with some loss of digital dexterity and sensation.

Implications:

• Proximal forearm transplantation can restore significant limb strength and function long-term.
• PFT is a viable option for select patients requiring extensive forearm reconstruction.
• Further research on long-term outcomes and patient selection for PFT is warranted.