Article

Bilateral forearm and hand transplantation poses unique challenges especially in
the setting of bilateral lower limb amputations. A 57-yr-old man with bilateral
transradial amputations and bilateral transtibial amputations after remote
streptococcal sepsis was admitted for inpatient rehabilitation because of severe
debilitation after forearm/hand transplantations. He required 6 wks of bed rest
to allow the healing of the allografts but developed profound deconditioning.
Because of weight-bearing precautions and other complications such as femoral
neurapraxia, he required the use of body weight-support apparatus to ambulate
with lower limb prostheses, keeping weight off the allografts. He progressed to
walking 600 ft using a platform-wheeled walker at a modified independent level,
to climbing four stairs with minimal assistance, and to being able to toss a
small football using his right hand, indicating improved flexor function in this
hand. Tacrolimus levels were maintained without clinical evidence of acute
rejection. Through an individualized therapy regimen, careful monitoring of the
allografts and dedicated support staff, rehabilitation training of a previous
quadrimembral amputee after bilateral hand transplantations can be successful.

Langue : ANGLAIS