Abstract
Purpose:
Little is known about bone healing after composite tissue transplantation that requires pharmacologic immunosuppression. Bone integration and callus development were assessed in bilateral hand transplantation.
Methods:
In this study the course of callus development and callus maturation were assessed by color Doppler sonography and radiography in a double hand transplant and compared with forearm replantation.
Results:
After hand transplantation, ingrowth of small vessels at the bone junction was observed at week 3, calcified callus became visible at month 4, and bone union was completed at month 11. A similar time course of bone integration was observed after replantation. Plating offered sufficient stability. A recipient periostal flap is thought to have improved blood supply and favored development and induction of callus.
Conclusions:
Bone healing after hand transplantation under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone is identical to that after forearm replantation.
MeSH terms
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Amputation, Traumatic / diagnostic imaging
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Amputation, Traumatic / immunology
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Amputation, Traumatic / surgery
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Blast Injuries / diagnostic imaging
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Blast Injuries / immunology
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Blast Injuries / surgery*
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Bone Regeneration / drug effects
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Bony Callus / blood supply
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Bony Callus / diagnostic imaging
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Bony Callus / drug effects
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Bony Callus / immunology
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Drug Therapy, Combination
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Follow-Up Studies
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Forearm Injuries / diagnostic imaging
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Forearm Injuries / immunology
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Forearm Injuries / surgery*
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Fracture Healing / drug effects*
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Hand / blood supply
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Hand Injuries / diagnostic imaging
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Hand Injuries / immunology
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Hand Injuries / surgery*
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Hand Transplantation*
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Humans
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Immunosuppressive Agents / adverse effects
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Immunosuppressive Agents / therapeutic use*
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Male
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Middle Aged
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Mycophenolic Acid / adverse effects
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Mycophenolic Acid / analogs & derivatives*
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Mycophenolic Acid / therapeutic use*
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Neovascularization, Physiologic / drug effects
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Prednisolone / adverse effects
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Prednisolone / therapeutic use*
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Replantation*
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Surgical Flaps / blood supply
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Tacrolimus / adverse effects
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Tacrolimus / therapeutic use*
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Ultrasonography, Doppler
Substances
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Immunosuppressive Agents
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Prednisolone
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Mycophenolic Acid
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Tacrolimus