Neural regeneration in allografted human two hands :one case analysis

doi:10.3321/j.issn:1673-8225.2004.29.020

Abstract：BACKGROUND: Cases of human hand allograft have been scarcely reported in the world, and the present case is the fourth in the world.OBJECTIVE: To explore nerve regeneration under immunosuppression in human hand allotransplantation.DESIGN: Case analysis.SETTING and PARTICIPANTS: The operation was performed in the First Affiliated Hospital of Harbin Medical University. A man aged 18 years old amputated 4cm above the carpus with two hands was admitted in January 2001.INTERVENTION: One case of two-hand allotransplantation was performed in one recipient with loss of two hands. The operation process was similar to the replantation of severed hand at wrist level. Transplantation involved sutures of median nerve, ulnar nerve and its dorsal cutaneous branch, and superficial branch of radial nerve. Combined immunosuppressive therapy including tacrolimus(progrnf, FK506) was used to suppress rejection.MAIN OUTCOME MEASURES: Neural regeneration, as assessed by the presence of Tinnel's signRESULTS: Transplanted hands survived well without immunorejection.Tinnel's sign showed that the nerve regenerates more than 50 mm in 1month, more than 100 mm in 2 months, and about 200 mm in 3 months after the operation, namely more than 2 mm per day. The sense of pain and temperature recovered to distal segment of thumb and proximal segment of the little fingers in 4 months. Hands were able to move actively to catch goods and paper, which accorded to the Tinnel's test.CONCLUSION: Neural regeneration is faster in hand allotransplantation under immunosuppression. The sense of hand can recover and intrinsic muscles are reinerverated in a short term, faster than those in autogenous limb replantation at the same level. It deserves further studies.