Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 391 - файл

and considered the procedure exempt from full review. Multiple preoperative rehearsals took place in preparation for the surgery. After a little over two months on the waitlist, an appropriate donor was found and the transplant was per­formed in a 10 h and 40 min operation with a large surgical team. In the early postoperative period, one of the hands became ischemic due to thrombosis of the ulnar artery which required immediate take back to the OR and revision of the anastomosis. The patient was hospitalized for ve weeks as an inpatient and for two weeks in inpatient rehab. By six months, the patient had regained light touch sensation of the hands. Around an eight-month posttransplant, the patient had clear intrinsic muscle function return in the right hand and by ten months in the left. This intrinsic function was also conrmed by functional MRI.During the rst year the patient had multiple bouts of acute rejection treated with a bolus of steroids and topical agents along with an increase in maintenance immunosuppression. As of 30-month follow-up, he has continued to improve in sensation, motor function, and psy­chosocial integration of the hands and is more independent with self-care such as eating, toilet­ing, and clothing himself. He is also able to write and to play sports such as baseball and football. Serial functional brain imaging studies including diffusion tensor imaging MRI and magnetoen­cephalography have demonstrated that the mas­sive cortical reorganization associated with amputation is reversible back to similar patterns to the pre-amputation state after transplantation of new hands [22].

process to help determine if a candidate has the psychological stability and resilience needed to cope with the vigorous demands of postoperative therapy, medical treatment, and close follow-up. The team should be prepared to provide the pedi­atric recipient with increased support as he/she transitions to adolescence and adulthood.