Shaun D Mendenhall1, Justyn Lutfy2, Emily Graham1, Bo Overschmidt1, L Scott Levin3, Michael W Neumeister4. 1. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA. 2. Kootenay Surgery Clinic, Trail, British Columbia, Canada. 3. University of Pennsylvania, Philadelphia, USA. 4. Southern Illinois University School of Medicine, Springfield, USA.
Abstract
Background: Hand and distal forearm allotransplantation has advanced over the last 20 years from experimental to a viable treatment option for bilateral upper extremity amputation. Despite widespread growth of this field, there are few technical reports that elaborate the details of donor arm procurement. This article details a technique for rapid donor procurement through the elbow for mid to distal forearm-level hand allograft procurement. Methods: Nine arm procurements were performed on deceased tissue-only donors provided by the local organ procurement organization, including two bilateral and five unilateral cases. Technique highlights include using a fishmouth incision through the lateral and medical epicondyles, identification of the neurovascular structures, and disarticulating the elbow joint. Results: Procuring through the elbow provides straightforward anatomy, bypasses the need to cut through bone, and allows tissue allotransplantation teams to achieve procurement, flushing, and packaging within 20 minutes. Conclusions: Procurement through the elbow is a simple procedure that streamlines the process for multi-organ donors by minimizing the time needed for hand allograft procurement. Team coordination and surgical rehearsals are essential for successful hand and upper extremity procurement and allotransplantation.
Background: Hand and distal forearm allotransplantation has advanced over the last 20 years from experimental to a viable treatment option for bilateral upper extremity amputation. Despite widespread growth of this field, there are few technical reports that elaborate the details of donor arm procurement. This article details a technique for rapid donor procurement through the elbow for mid to distal forearm-level hand allograft procurement. Methods: Nine arm procurements were performed on deceased tissue-only donors provided by the local organ procurement organization, including two bilateral and five unilateral cases. Technique highlights include using a fishmouth incision through the lateral and medical epicondyles, identification of the neurovascular structures, and disarticulating the elbow joint. Results: Procuring through the elbow provides straightforward anatomy, bypasses the need to cut through bone, and allows tissue allotransplantation teams to achieve procurement, flushing, and packaging within 20 minutes. Conclusions: Procurement through the elbow is a simple procedure that streamlines the process for multi-organ donors by minimizing the time needed for hand allograft procurement. Team coordination and surgical rehearsals are essential for successful hand and upper extremity procurement and allotransplantation.
Authors: Warren C Breidenbach; Edward A Meister; Tolga Turker; Giles W Becker; Vijay S Gorantla; L Scott Levin Journal: Plast Reconstr Surg Date: 2016-01 Impact factor: 4.730
Authors: Warren C Breidenbach; Edward A Meister; Giles W Becker; Tolga Turker; Vijay S Gorantla; Kareem Hassan; Bruce Kaplan Journal: Plast Reconstr Surg Date: 2016-01 Impact factor: 4.730
Authors: Nicholas Pulos; Abraham Shaked; Peter L Abt; Stacey L Doll; Christine T McAndrew; Benjamin Chang; L Scott Levin Journal: Tech Hand Up Extrem Surg Date: 2015-06