Technique for Rapid Hand Transplant Donor Procurement Through the Elbow. (May 2021)

• Record Type: Journal Article
• Authors: Mendenhall, Shaun D.; Lutfy, Justyn; Graham, Emily; Overschmidt, Bo; Levin, L. Scott; Neumeister, Michael W.
• Is Part Of: Hand. Volume 16:Number 3(2021)
• Page Start: 391
• Page End: 396
• Publication Date: 2021-05
• Subjects: allograft -- basic science -- composite tissue allotransplantaion -- amputation -- trauma -- diagnosis -- hand -- anatomy -- forearm; Hand -- Surgery -- Periodicals; Hand -- Surgery; Periodicals; 617.57005
• DOI: 10.1177/1558944719863127
• Languages: English
• ISSNs: 1558-9447

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.