Bilateral forearm and
hand transplantation poses unique challenges especially in the setting of bilateral lower limb
amputations. A 57-yr-old man with bilateral transradial
amputations and bilateral transtibial
amputations after remote streptococcal
sepsis was admitted for inpatient rehabilitation because of severe debilitation after forearm/hand
transplantations. He required 6 wks of
bed rest to allow the healing of the allografts but developed profound deconditioning. Because of weight-bearing precautions and other complications such as femoral neurapraxia, he required the use of
body weight-support apparatus to ambulate with lower limb
prostheses, keeping weight off the allografts. He progressed to walking 600 ft using a platform-wheeled walker at a modified independent level, to climbing four stairs with minimal assistance, and to being able to toss a small football using his right hand, indicating improved flexor function in this hand.
Tacrolimus levels were maintained without clinical evidence of acute rejection. Through an individualized
therapy regimen, careful monitoring of the allografts and dedicated support staff, rehabilitation training of a previous quadrimembral amputee after bilateral hand
transplantations can be successful.