A Cadaver Study of the Feasibility of Multidigit Allotransplantation for Reconstruction of the Metacarpal Hand. 2015

Antonio Rampazzo, and Joseph Edward Kutz, and Christina Kaufman, and Yorell Manon-Matos, and Linda Bright, and Francis Anthony Papay, and Bahar Bassiri Gharb
Cleveland, Ohio; and Louisville, Ky. From the Plastic Surgery Department, Cleveland Clinic; the Christine M. Kleinert Institute, University of Louisville; and the Radiology Department, Jewish Hospital and St. Mary's Health Care.

BACKGROUND Amputation of all fingers (metacarpal hand) can be functionally equivalent to hand amputation. Multidigit allotransplantation can benefit patients who require a full complement of fingers to return to their preinjury activities. The authors investigated the feasibility of the transfer of four fingers and thumb as a single allograft. METHODS Four fingers and the thumb were harvested from 16 hands as an allograft based on the radial and ulnar arteries. Dorsal digital veins were dissected until confluent in the major veins. The common digital nerves were divided at the origin. The flexor and extensor tendons were transected, respectively, in zones V and VI. The fingers were disarticulated at the metacarpophalangeal joint. After harvest, ulnar and radial arteries were injected with red and blue India ink, respectively, followed by injection of lead gel in the ulnar artery to study the perfusion of the fingers. Digital radiographs and computed tomographic scans were obtained. A bilateral mock transplantation was performed. RESULTS The ulnar artery perfused the small, ring, long, and ulnar half of the index finger, whereas the radial artery vascularized the thumb. The index finger represented a watershed area. The presence of contrast in the four fingers, decreasing toward the radial fingers, was confirmed by computed tomography. The mock transplantation procedure was performed successfully. CONCLUSIONS Multidigit transplantation is an anatomically feasible procedure. Although the ulnar artery can supply the entire allograft, the variable anatomy of the palmar arches should be considered and the flap based on both ulnar and radial arteries.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D005240 Feasibility Studies Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project. Feasibility Study,Studies, Feasibility,Study, Feasibility
D005383 Finger Injuries General or unspecified injuries involving the fingers. Injuries, Finger,Finger Injury,Injury, Finger
D005385 Fingers Four or five slender jointed digits in humans and primates, attached to each HAND. Finger
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D000673 Amputation, Traumatic Loss of a limb or other bodily appendage by accidental injury. Amputations, Traumatic,Traumatic Amputation,Traumatic Amputations
D019651 Plastic Surgery Procedures Procedures used to reconstruct, restore, or improve defective, damaged, or missing structures. Cosmetic Reconstructive Surgical Procedures,Cosmetic Surgical Procedures,Esthetic Reconstructive Surgical Procedures,Esthetic Surgical Procedures,Plastic Surgical Procedures,Reconstructive Surgical Procedures,Reconstructive Surgical Procedures, Cosmetic,Cosmetic Reconstructive Surgery,Procedure, Reconstructive Surgical,Procedures, Reconstructive Surgical,Reconstructive Surgical Procedure,Reconstructive Surgical Procedures, Esthetic,Surgical Procedure, Reconstructive,Surgical Procedures, Reconstructive,Cosmetic Reconstructive Surgeries,Cosmetic Surgical Procedure,Esthetic Surgical Procedure,Plastic Surgery Procedure,Plastic Surgical Procedure,Procedure, Cosmetic Surgical,Procedure, Esthetic Surgical,Procedure, Plastic Surgery,Procedure, Plastic Surgical,Procedures, Cosmetic Surgical,Procedures, Esthetic Surgical,Procedures, Plastic Surgery,Procedures, Plastic Surgical,Reconstructive Surgeries, Cosmetic,Reconstructive Surgery, Cosmetic,Surgeries, Cosmetic Reconstructive,Surgery Procedure, Plastic,Surgery Procedures, Plastic,Surgery, Cosmetic Reconstructive,Surgical Procedure, Cosmetic,Surgical Procedure, Esthetic,Surgical Procedure, Plastic,Surgical Procedures, Cosmetic,Surgical Procedures, Esthetic,Surgical Procedures, Plastic
D063986 Vascularized Composite Allotransplantation Transference of multiple tissues, such as muscle, bone, nerve, and skin, as a functional unit for reconstructive purposes. Blood supply to the transplanted tissues is maintained throughout the transplantation procedure with minimal ischemia. Maintenance of vascularity in the graft promotes its viability, function, and survival in the recipient. Composite Tissue Allogeneic Transplantation,Composite Tissue Allografting,Composite Tissue Allotransplantation,Vascularized Composite Allografting,Allografting, Composite Tissue,Allografting, Vascularized Composite,Allotransplantation, Composite Tissue,Allotransplantation, Vascularized Composite

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