Although VCA includes a range of surgical procedures such as face and extremity transplantation, this paper focuses primarily on our institutional experience with the recipients of hand allotransplantation. Hand transplantation involves the systematic integration of donor upper extremity tissues to the recipient beginning with the attachment selleck of bone, followed by tendons, nerves, vessels, and cutaneous tissues, with multiple teams working in tandem to attach the donor limb. Given the surgical complexity, extensive presurgical planning and close follow-up are required. It is therefore imperative that clinicians be cognizant of which radiologic findings are pertinent in operative planning and subsequent patient care, particularly as VCA transplantation becomes more common.
Thus, the aim of this paper is to utilize our institutional experience in order to optimize the radiologic understanding of this unique patient population, about whom little exists in the current imaging literature. 2. Subjects and Methods The institutional review board approved this retrospective review of HIPAA-compliant patient data, without the need for individual consent. 150 patient referrals were reviewed which yielded 19 patients that were initially considered for upper extremity allotransplantation. Of these, five patients ranging in age between 27 and 59 years with a mean age of 37 underwent transplantation. Three males and two females were selected, with three having experienced amputation secondary to extremity gangrene from sepsis and two having undergone traumatic amputation.
Three of the five patients had experienced quadrilateral amputations. This group underwent a combined total of 8 upper extremity transplantations. A systematic retrospective review was performed of the imaging and clinical records obtained from 2008 to 2011. This review included both preoperative screening and postoperative surveillance imaging within the musculoskeletal and vascular radiology subdivisions. 2.1. Presurgical Work-Up Individuals considered for transplant candidacy underwent extensive preoperative radiologic evaluation; all began with conventional digital radiography of the residual limb to evaluate bone integrity and the length of the remaining long bones. However, the combination of subsequent imaging modalities was individualized based on each patient’s mechanism of injury, surgical history, and initial findings on radiography.
Radiographs were obtained at the level of injury and proximally, with particular attention to the inclusion of the proximal joints. 64-slice CT (GE LightSpeed VCT) with 2D reformatting was obtained when further characterization of bone defects, such as displacement of residual bone fragments and fracture extension, Dacomitinib was needed. Those with prior reconstruction attempts underwent 1.5 Tesla (GE HD16.