American Association of Plastic Surgeons

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Functional Outcome of Transhumeral Arm Transplantation
Jaimie Shores, MD1, Carisa Cooney, MPH1, Damon Cooney, MD1, James Higgins, MD2, Joseph Losee, MD3, Princess Phillipi, CHT1, Gerald Brandacher, MD1, WP Andrew Lee, MD1.
1Johns Hopkins University, Baltimore, MD, USA, 2Curtis National Hand Center, Union Memorial Hospital, Baltimore, MD, USA, 3University of Pittsburgh, Pittsburgh, PA, USA.

PURPOSE:
Few of the >120 hand transplants performed world wide have been transhumeral due to concerns about functional outcome. We report our experience in 4 patients who received transhumeral arm transplantation.
METHODS:
Under an IRB oversight, a single bilateral transhumeral transplant was performed in 2017 and unilateral transhumeral transplants were performed in 3 amputees as follows: (1) in conjunction with a contralateral distal forearm transplant in 2010, (2) in conjunction with a contralateral total forearm transplant in 2012, (3) with an intact contralateral arm in 2015.
RESULTS:
As our fourth transplant is only 11 months into recovery at this time, we are reporting the functional results of the preceding three. With sustained therapy, all 3 transplanted arms developed significant functional returns. Follow-up at 2, 5, and 7 years showed average active elbow flexion 130, elbow extension 3, wrist flexion 53, wrist extension 60, total finger flexion 215. Sensory return ranged 3.61-5.46 by Semmes-Weinstein (except 3 digits) at >2 years, and grip strength averaged 15.3 lb and pinch 2 lb. Carroll tests ranged 26-47, and DASH 0-37, and ARAT ranged 24-51. All recipients fully incorporate their transplanted arms in independent activities of daily living, including eating, bathing, exercising, and driving.
CONCLUSION:
While more distal upper extremity transplantation results in better recovery, transhumeral transplants provide significant functional capability in proximal amputees who otherwise have minimal function and often shun prosthetics. Transhumeral arm transplantation may contribute to autonomous and productive lives and should be considered a treatment option in properly selected patients.


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