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Hand transplantation in patients with extensive burns of the upper extremities: anatomical study of the feasibility
Edoardo Dalla Pozza, MD
Bahar Bassiri Gharb, MD, PhD
Steckler Andrew, MS
Richard L. Drake, PhD
Francis Papay, MD, FACS
Antonio Rampazzo, MD, PhD
Department of Plastic Surgery,
Cleveland Clinic,
Cleveland, OH
2017-02-15
Presenter: Edoardo Dalla Pozza
Affidavit:
Dr. Edoardo Dalla Pozza was the main researcher involved in this project. He performed all the dissections with help and guidance by the senior author.
Director Name: Bahar Bassiri Gharb
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Hand
Introduction:
This anatomical study aims to evaluate a hand transplant model harvested with increased amounts of
skin from the upper extremity to replace the scarred recipient skin in severely burned patients.
Methods:
25 upper limbs were studied. Based on the vascular anatomy of the perforators, forearm based hand allografts were harvested with 3 different patterns: A) volar and dorsal forearm flaps based only on distal perforators and islanded medial arm flap; B) volar and dorsal forearm flaps with preservation of proximal radial perforators and islanded medial arm flap C) dorsal forearm flap and extended medial arm- volar forearm skin flap. 16 samples were injected with latex to map the perforating branches of the brachial (BA), Superior Ulnar Collateral (SUCA), Radial (RA), Ulnar (UA) and Posterior Interosseous (PIA) arteries. 3 samples for each group were dissected and injected with blue ink from the BA to assess the perfusion.
Results:
The medial arm flap was constantly supplied by perforators from the BA and the SUCA (respectively 4.35±1.64, diameter 1.03±0.34mm and 2.6±0.76, diameter 0.90±0.34mm). Perforators from RA (9.3±1.62) and UA (6.7±2.7) were constantly found. The harvesting of the PIA with its perforators (5.25±0.95) provided vascularization to the posterior flap by distal anastomosis.
Conclusions:
The medial arm flap should be safely based on perforators from the BA and/or SUCA. The design of the specimens in group B proved to be the most effective when comparing vascularization reliability and versatility as did not interfere with the dissection and repair of vessels, tendons and nerves.
