First Successful Lower-Extremity Transplantation: Technique and Functional Result

ABSTRACT

Composite tissue transplantation has emerged as a viable alternative to prosthetics and complex reconstructive surgery. Thus far it is reserved for cases which cannot be effectively reconstructed and where it offers some benefits over prostheses. It has been used in the upper extremity with encouraging results and, most recently, in the face. This report outlines what is believed to be the first such use in the lower extremity. A normal lower limb in a 3-month-old ischiopagus twin who was not going to survive was transplanted to the appropriate pelvic position, revascularized, and reinnervated in an otherwise healthy sister. The limb survived and, because of the immune compatibility, did not require immune suppressive therapy. The return of muscle function in the transplanted limb is encouraging. The transplanted limb appears to be fully sensate. In addition to reinnervation, the limb is now spontaneously under the cortical control of the recipient.

KEYWORDS

Transplantation - conjoined twins - lower extremity

REFERENCES

• 1 Spencer R. Theoretical and analytical embryology of conjoined twins: part I: embryogenesis.  Clin Anat. 2000;  13 36-53
• 2 Dubernard J M, Owen E, Herzberg G et al.. Human hand allograft: report on first 6 months.  Lancet. 1999;  353 1315-1320
• 3 Dubernard J M, Petruzzo P, Lanzetta M et al.. Functional results of the first human double-hand transplantation.  Ann Surg. 2003;  238 128-136
• 4 Margreiter R, Brandacher G, Ninkovic M et al.. A double-hand transplant can be worth the effort.  Transplantation. 2002;  74 85-90
• 5 Strome M. Human laryngeal transplantation: considerations and implications.  Microsurgery. 2000;  20 372-374
• 6 Strome M, Stein J, Esclamado R et al.. Laryngeal transplantation and 40-month follow-up.  N Engl J Med. 2001;  344 1676-1679
• 7 Hofmann G O, Kirschner M H, Wagner F D et al.. Allogeneic vascularized grafting of a human knee joint with postoperative immunosuppression.  Arch Orthop Trauma Surg. 1997;  116 125-128
• 8 Kirscher G O, Brauns L, Gunschorek O et al.. Vascularized knee joint transplantation in man: the first two years' experience.  Eur J Surgery. 2000;  166 320-327
• 9 Guimberteau J C, Baudet J, Panconi B et al.. Human allotransplantation of a digital flexion system vascularized on the ulnar pedicle: a preliminary report and 1-year follow-up of two cases.  Plast Reconstr Surg. 1992;  8 1135-1147