F70. Hand reinnervation after a bilateral proximal forearm transplantation, 5 years evolution

Introduction After hand transplantation distal muscles may become useless well before they can be reinnervated. This is a major reason why proximal forearm transplants remain controversial. Sensory and autonomic reinnervation is a complex process which has not been studied even in peripheral nerve injured. Methods A 52 year old male, underwent forearm transplantation. The following studies have been performed regularly on both arms: Motor neurography studies to ulnar, median and radial nerves, sensory neurography studies to median and ulnar nerves, needle electromyographic studies on intrinsic hand muscles, somatosensory evoked responses and autonomic neurophysiologic studies. Results Median and ulnar motor nerve neurography studies have shown continuous increase of all values of compound muscle action potentials (CMAP) in the five year observation period. Needle electromyographic studies show reinnervation signs on motor unit action potentials (MUAPS) of intrinsic muscles of both hands, neurography sensory studies have not shown a reliable measure of sensory nerve action potential (SNAPS), somatosensory evoked potentials (SEP) with stimulus at wrist elicited almost normal cortex responses at 3 years post-transplantation, autonomic reinnervation is present. Conclusion Motor, sensory and autonomic reinnervation to the hand has been a continuous process in the five years observation period in this transplanted patient.Intrinsic muscles in the hand show neurophisiologic signs of being reinervated. We still expect neurophysiologic and clinical improvement.