Indian Subcontinent's First Proximal Forearm Level Double Upper Extremity Transplantation

Area of Science:

• Reconstructive surgery
• Transplantation immunology

Background:

• Vascularized composite allotransplantation (VCA) represents an advanced reconstructive option for severe upper limb amputations.
• Proximal forearm level amputation presents unique surgical challenges compared to distal levels.

Purpose of the Study:

• To detail the technical aspects of proximal forearm level double upper extremity transplantation.
• To outline immediate post-transplant monitoring and immunosuppression protocols.
• To discuss the distinct surgical considerations and functional recovery of proximal forearm VCA.

Main Methods:

• A case report of a 24-year-old male with bilateral proximal forearm amputation due to electrical injury.
• The patient underwent a bilateral proximal forearm level double upper extremity transplantation.
• Post-transplant management included stringent immunosuppression and physical rehabilitation.

Main Results:

• The procedure successfully restored the "donor extremity length" and maintained functional muscle length.
• Functional recovery is dependent on reinnervation of the transplanted muscles over time.
• The study highlights the complexity and decision-making involved in this specific level of transplantation.

Conclusions:

• Proximal forearm VCA requires meticulous surgical planning and team familiarity.
• Mock cadaver dissections are recommended to standardize the procedure and enhance team preparedness.
• VCA provides a significant reconstructive advancement for complex upper limb loss.