Lymphedema after upper limb transplantation: scintigraphic study in 3 patients

Ann Plast Surg. 2013 Jul;71(1):114-7. doi: 10.1097/SAP.0b013e31828349ff.

Abstract

Lymphatic vasculature is known to spontaneously reconnect after hand replantation. Nonetheless, lymphatic outflow has not been specifically studied in hand transplantation.Lymphedema was studied clinically and scintigraphically in 3 bilateral upper limb transplants performed in Valencia, Spain, since 2006. Case 1 was a radiocarpal level, case 2 midforearm and proximal forearm, and case 3 was a transhumeral transplantation. Follow-up was 5, 4, and 3 years, respectively. Clinically, in case 1, there was a left-sided moderate lymphedema, case 2 was normal, and a right-sided moderate lymphedema was present in case 3. Lymphoscintigraphy results were consistent with the clinical findings. It was normal in the 4 nonedematous limbs. In the 2 affected limbs, there were scintigraphic findings of lymphatic block and lymphangiectasia.The study demonstrates objectively that lymphatic circulation can reconnect spontaneously in hand transplantations, although not in a homogeneously efficient way.

MeSH terms

  • Amputation, Traumatic / surgery
  • Forearm / surgery
  • Forearm Injuries / surgery*
  • Hand Transplantation
  • Humans
  • Lymphangiectasis / diagnostic imaging
  • Lymphatic Vessels / physiopathology*
  • Lymphedema / diagnostic imaging*
  • Lymphedema / physiopathology
  • Radionuclide Imaging
  • Radiopharmaceuticals
  • Technetium Tc 99m Sulfur Colloid
  • Upper Extremity / surgery*
  • Vascularized Composite Allotransplantation

Substances

  • Radiopharmaceuticals
  • Technetium Tc 99m Sulfur Colloid