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4-year Follow-up Of The World’S First Pediatric Bilateral Hand-forearm Transplants: The Growth And Progress Continues
Said Azoury, MD1, Niv Milbar1, Rotem Kimia1, Jie C. Nguyen2, Christine McAndrew, PA-C1, Stephen Kovach1, Robert Carrigan1, David Steinberg, MD1, David J. Bozentka, MD1, Ines Lin, MD MEd1, L. Scott Levin, MD1, Benjamin Chang, MD1.
1University of Pennsylvania, Philadelphia, PA, USA, 2Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Introduction: In 2015, the first bilateral pediatric hand-forearm transplant was performed in an 8-year old boy. The long-term functional outcomes and growth of transplanted upper extremities was unknown.
Methods: Forearm and bone age radiographs were obtained annually. Radius and ulna measurements were performed and mathematically normalized by a pediatric musculoskeletal radiologist (JCN) alongside coauthors (SCA, NM, RK). Greulich & Pyle Atlas was used to estimate hand bone age. Functional testing and patient reported outcomes are reviewed.
Results: From July 2015 to July 2019, bone length increased 33 mm and 37 mm for right ulna and radius, 38 mm and 37 mm for left ulna and radius, respectively. Distal physes of the donor limbs increasingly contributed to overall bone length relative to proximal physes, which grew slowly (figure). Normalized growth between the two limbs was statistically similar (p>0.05). At each annual follow-up, the bone age increased by 1-year. Bone healing resulted in normal structure in the transplanted and recipient bone. Motor, sensory and functional independence measures are encouraging. No pain was noted (0) during exercises (0-10 scale).
Conclusions: Successful pediatric hand-forearm transplantation offers the advantage of growth similar to non-transplanted pediatric patients. The transplanted distal physes contributes more to the overall growth, paralleling normal pediatric growth patterns. The patient continues to make gains in all domains, functional activities of daily living and grasping.


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