Simon Kay

Bilateral hand transplantation: Functional benefits assessment in five patients with a mean follow-up of 7.6 years (range 4-13 years).

Between January 2000 and July 2009, five adults who had suffered bilateral traumatic below-elbow amputations, received bilateral hand-forearm allografts performed by the Lyon team. We report the functional benefits achieved over a mean follow-up period of 7.6 years (range 4-13 years), up to December 31st, 2013. Clinical measurement is hampered by the lack of specific validated assessment tools, obliging us to use non-specific standardized evaluation means. Our assessment shows that the restoration of motion, strength, and sensibility are fair. Functional results (Carroll upper extremity function test, 400-point test, Activities of daily living) are good, as well as quality of life evaluation (RAND-36). Subjective and overall results explored with questionnaires - Disabilities of the Arm Shoulder and Hand (DASH), Hand Transplantation Score System (HTSS), are very good. Improvement was seen to continue during the first three years, and then tend to become stable. Continued efforts should be directed at designing comprehensive, condition-specific, reliable outcome measurement tools. Continuous monitoring and evaluation of patients is required to assess the long-term risk-benefit balance.

iii) Obstetrical brachial palsy

Obstetrical brachial plexus palsy (OBPP) results from damage to the brachial plexus of the baby during delivery. It is due to traction across the plexus as a result of forces applied either to the head or to the arm, directly or indirectly. First recorded as an entity in 1779 by the English obstetrician Smellie/ the mechanical origin of the condition was proposed by Duchenne, 2 and its anatomical basis elucidated by Erb 3 and Klumpke. 4 Over the years, many other explanations for obstetrical brachial palsy have been proposed. None has found credence, with the exception of the proposition that in some cases the palsy has resulted from an in utero event? There have been rare and sporadic reports supporting the above but difficulties arise in establishing the origins of such cases, and separating them from that rare condition, partial agenesis of the brachial plexus. Such debate is likely to continue because of the medico-legal implications. However, it is certain that the vast majority if not all cases of OBPP result from traction forces during delivery?