Transplantation of a Full-Cut Upper Limb from the Middle Third of the Arm: A Case Report

The first upper limb transplant with acceptable function was reported in 1963. Afterwards with progress in microvascular surgery, outcomes improved. A brief report of experience concerning transplantation in the United States, China and Switzerland published in 1981 revealed that 1/3 of the patients had excellent, 1/3 good, and 1/3 had poor results. Regarding shoulder transplant, all results were poor and the rate of success with sharp cut lesions was higher than avulsion types. Case Report: An 11-year-old boy was taken to the emergency room while he was conscious but in a state of pain shock. Being restless, he had blood pressure of 80/50mmHg and heart rate of 120 per minute. His left upper limb was totally avulled from the middle third of the arm. The stump was so dirty and bleeding continuously. The amputated limb was in a dirty plastic bag with some ice chips on it. The patient was referred to the operation room and transplant was done. Then he was followed up monthly. Transplantation in shoulder area is hardly ever followed by excellent or satisfactory outcomes. The rate of success, acceptable function, in transplantation of different parts of the arm is as following: 0-40% above the elbow, 0-70% in proximal forearm, 50-83% in distal forearm, 80% in the wrist, 25-70% in the palm, 32-90% in the thumb, 70% in proximal PIP(Proximal Interphalangeal) in fingers, and 100% in distal PIP. Sharp cut traumas have better results than crushing ones, but avulsion types are the worst. However, vascular transplant was successfully performed on the above-mentioned case, and he was referred to a well equipped center for neural transplant.