2016年4月, 加州大学旧金山分校健康 doctors performed a first-of-its-kind elbow transplant between the same patient's arms. Experts say the surgery could transform treatment for trauma patients, injured veterans and others with elbow and joint conditions.
"The fact that the donor elbow came from the same patient – a mirror-image elbow – is what makes this procedure unique and the first of its kind,UCSF健康外科十大赌博平台排行榜Dr. Lisa Lattanza said of the transplant performed for 37-year-old Reginald Cook.
The 12-hour procedure involved five surgeons, two orthopedic upper extremity specialists and three plastic-microvascular surgeons. The doctors worked on both of Cook's arms simultaneously to remove and connect bone, 肌肉, 血管, 神经和皮肤.
“这个手术有点像芭蕾,拉坦莎说, who led the team that transplanted Cook's left elbow into his right arm. "Everybody knew their part and performed flawlessly at just the right time."
A 2009 car accident left Cook, of El Paso, Texas, in a coma for months. 他遭受了脑部创伤, several broken bones in his neck and paralysis in his legs, 需要轮椅.
Cook also suffered a complete detachment of the brachial plexus, a network of nerves that control movement and sensation in the arm and hand, from his left arm and failed to recover any nerve function there. Despite multiple reconstructive procedures to repair a shattered elbow in his right arm, Cook wound up with no right elbow joint and later only half the bone in that limb after an implanted elbow joint became infected.
结果是, he could no longer control his right arm for even simple tasks like eating, although he did have good movement of his right hand. Cook relied on his sister and a visiting nurse for care.
"He did not have use of either arm," said Dr. Eric 国, Cook's orthopedic surgeon in Texas who worked with Lattanza on the case. "His right arm was basically frozen at 90 degrees, and his left arm was completely nonfunctional."
国, an assistant professor at Texas Tech University Health Sciences Center El Paso, first met Lattanza in the mid-1990s when the two were residents at the University of Missouri-Kansas City. He contacted Lattanza after Cook suggested the idea of an elbow transplant, 希望能重新使用他的一只手臂.
国 and Cook traveled to San Francisco to meet with Lattanza in November 2015. The procedure was potentially risky since Cook could lose function in his right hand, due to possible nerve damage during the operation, as well as scar tissue from the previous infection and surgeries.
In the months leading up to the procedure, Lattanza worked with UCSF colleagues and consultants around the world to devise the novel surgery, which would remove Cook's left arm from above the elbow and transplant that elbow to his right arm. The team also used 3-D computer modeling software from Belgian company Materialise to help plan the surgery.
UCSF健康外科团队包括Dr. 斯科特·汉森博士. 李焯权博士. 迈克尔·特里和博士. 萨曼莎风笛手. Alyssa Ricker, principal clinical engineer for Materialise, served as imaging consultant.
尽管规划广泛, Lattanza and her team made adjustments on the fly during the surgery because Cook's anatomy had changed since his initial visit.
“骨头恢复得很好, the joint is working well and the flap is alive,拉坦扎在库克手术后说. "He's moving his right hand, so there was no nerve damage during the operation. 我们都对结果充满希望."
She added that one month after the transplant, Cook was able to lift his hand to his face and mouth on his own.
"I'm now feeling touch and sensations," Cook said. He stayed in San Francisco for several weeks after the surgery while doctors monitored his progress.
国 said he hoped his patient would regain the ability to dress and feed himself over the next year – and possibly even walk again.
"If we can make the arm strong enough, he should be OK to walk with a cane," 国 said.
Cook restarted physical therapy in his right arm, and his left arm had suitable anchoring for a prosthesis if desired, 他的十大赌博平台排行榜说.
"I can't wait to be independent and give my 14-year-old daughter a big hug,库克说。, who hopes to become a motivational speaker. “这改变了我的生活."
