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1
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Umbilical Cord And Foetal Placenta Vessels As Biological Material In Microsurgical Techniques Training - Own Experiments

100%
Elsaftawy A., Jabłecki J.
Polish Journal of Surgery
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2010
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vol. 82
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issue 10
581-583
EN
For dozens of years microsurgical techniques have been successfully applied in various procedural areas mainly in ophthalmology, laryngology, female infertility treatment, urology, plastic surgery and reconstruction as well as hand surgery. Courses enabling acquisition of basic qualifications within the microsurgical techniques area are the starting point for such activity, there is however an urgent need for further training as it goes without saying that without adequate training one may quickly forget all the experience gained during such trainings. Our department have been using foetal placenta obtained from maternity ward (following a written consent from a parturient) to carry out microsurgical trainings for 13 months now.
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Upper Limb Transplantation - The Current State of Knowledge

100%
Chełmoński A., Jabłecki J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 8
562-569
3
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Acute compartment syndrome after open forearm fracture – scale of the problem and case report

100%
Elsaftawy A., Jabłecki J.
Polish Journal of Surgery
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2015
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vol. 86
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issue 1
44-47
EN
Acute compartment syndrome is caused due to a sudden increase in the tissue pressure in a given fascial compartment. Missed and undiagnosed or not treated in time can lead to irreversible damage to limb muscles and nerves due to ischemia mechanism. This paper presents a case of a patient with an open forearm fracture treated conservatively in plaster.
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Post-Traumatic Thumb Reconstruction with Radial Forearm Flap

100%
Elsaftawy A., Jabłecki J.
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vol. 85
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issue 6
351-353
EN
The study described a case of a 37-year-old patient, who had undergone avulsion amputation of the thumb, and was subject to a primary thumb reconstruction by means of thumb reconstruction with radial forearm flap, with the use of osseous fragments of the amputated thumb parts.
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Unsuccessful replantation of metacarpal hand after venous thrombosis – case report

100%
Elsaftawy A., Jabłecki J.
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vol. 85
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issue 12
721-726
EN
Trans-metacarpal hand replantation is one of the most complex and difficult procedures in the reconstructive microsurgery. As far as we know the arrangement of the palmar arterial network, the problem lies in the absence of accurate venous maps at the dorsum of the hand. The quality of venous circulation structure at the replanted hand determine the success of the surgery. In this paper we present a case of a failed replantation of a metacarpal hand after early thrombosis at the venous microcirculation system.
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Epidemiological Characteristic of Acute Pancreatitis in Trzebnica District

81%
Bogdan J., Elsaftawy A., Kaczmarzyk J., Jabłecki J.
Polish Journal of Surgery
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2012
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vol. 84
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issue 2
70-75
EN
Acute pancreatitis is one of the most common surgical disease, and thus cause of hospitalization. Incidence and etiology of this condition demonstrates large regional differences. This situation is a substantial financial burden forhospital district, and changes in organization structure and funding medical service should be taken under consideration.The aim of the study was to record the epidemiology with etiology, diagnosis and treatment of acute pancreatitis in large district (77 000 inhabitants).Material and methods. A meta-analysis study of all 298 patients admitted to Hospital St Hedwig in Trzebnica, in the six-year period from 2005 to 2010, with acute pancreatitis was performed.Results. Acute pancreatitis was diagnosed in 298 patients in the six - year period, giving an estimated incidence of 64.4 per 100 000. Among the group of 441 admissions for acute pancreatitis in 298 patients was confirmed. Severe acute pancreatitis developed in 22.5% (67/298) of patients, more often in males 56/208 (27%) than in females 11/90 (12%). Gallstones were found as an etiological factor in 27% (80/298), and alcohol intake in 49% of patients. 211/298 (70%) patients had only one attack, whereas 29% (87/298) were readmitted with 230 relapses. The risk of recurrent pancreatitis was 48% in alcohol induced and 6,25% in gallstone induced pancreatitis. 53/298 patients (17%) were operated, ERCP procedures were performed in 24.Performed operations: necrosectomy in 25/53 (47%), elective cholecystectomy in 16/53 (30%), open drainage of abdominal abscess in 5/53 (9%), open drainage of cysts in 5/53 (9%), Jurasz's operation in 2/53 (3%). Majority surgical treatment was carried out in 68% cases with severe acute pancreatitis. Mortality due to acute pancreatitis was 3% (10/298); 15% in severe pancreatitis.Conclusions. 1. Acute pancreatitis continues to be an important clinical problem. 2. Severe, necrotic acute pancreatitis is associated with high mortality rates. 3. The ethanol-intake-related episodes of acute pancreatitits are much more prevalent than the gall-stone-related ones. 4. After the exclusion of ethanol- and gall-stones-related etiologies, the subsequent diagnostic process should aim at excluding neoplastic process of the head of pancreas.
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Variety of Clinical Manifestations of Rupture of Iliopsoas Muscle Belly

81%
Paruzel M., Jabłecki J., Całka K.
Polish Journal of Surgery
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2009
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vol. 81
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issue 8
354-358
EN
Three patients are presented who sustained a lesion of iliopsoas muscle belly accompanied by intramuscular haematoma. Diagnosis was stated by means of CT scans. The accident such as fall of the stairs was the cause of the lesion in only two patients. The clinical manifestation of the illness significantly differed in symptoms such as: presence of subcutaneous haematomas, muscle tension, extent of pain, a drop of hemoglobin serum - level and others. The common feature of this mutilation was the maximal localization of the pain at the groin region of the affected side, difficulties in thigh dorsiflexion and external rotation as well as subsiding of symptoms after short-term conservative treatment. The characteristic of this rarely-diagnosed mutilation was analyzed on the basis of medical literature.
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Application of Leeches in Treatment of Microcirculation Disturbances of Replanted Fingers - a Preliminary Report

81%
Paruzel M., Jabłecki J., Domanasiewicz A., Kaczmarzyk L.
Polish Journal of Surgery
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2007
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vol. 79
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issue 8
548-554
EN
The aim of the study was to present the possibilities of application of leeches in cases of disturbances of venal out-flaw in replanted digits.Material and methods. In the period of 28 months 11 male patients aged between 19 and 51 years were subject to treatment with leeches. The group comprised 11 patients who had finger replantation or revascularization performed, and one patient who had second-toe-transfer. The indication for treatment were venal out-flaw disturbances of different etiology and their prophylaxis. Leeches were usually applied every 12 hours (two leech on one finger), the duration of treatment was from 2 to 6 days (4 days on average). After an effective application the animals were utilized. The antibiotics of aminoglicozides group were used as a prophylaxis of Aeromonas hydrophilia's infection.Results. All of the fingers treated with leeches survived. A dramatic improvement of local state of the fingers could be seen soon after the application of leeches. All of the patients did not complain of any discomfort associated with the therapy.Conclusion. The application of leeches in cases of disturbances venal out - flaw in replanted digits seems to be a valuable alternative of other methods commonly used.
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Early Results of Open Fasciotomy as a Treatment of Dupuytren's Disease in Elderly Patients

81%
Jabłecki J., Kaczmarzyk L., Domanasiewicz A., Kaczmarzyk J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 12
746-752
EN
The demand for treatment of Dupuytren's disease by a procedure of limited invasiveness and quick recovery is increasing in accordance with aging of the Polish population. Such a demand is fulfilled by different types of fasciotomy (open, percutaneous needle fasciotomy).The aim of the study was to asses the early results of the open fasciotomy in elderly patients.Material and methods. We treated 38 patients (61 fingers) whose mean age was 72 (SD 12) by open fasciotomy; 43 fingers presented stage III Tubiana contracture, 18 stage IV. The pre-operative total passive extension deficit was 123° (78° for stage III group, 111° for stage IV group). All the procedures were performed in outpatient setting. Patients used splint for 5 days, then performed finger - extension exercises and were encouraged to use their hands normally after 1 week.Results. The evaluation of the results was performed 4 weeks post-op. The greatest improvement in both of the groups was noted in MCP joint - 80% and in PIP joint - 48%, this difference is statistically significant. The general improvement ratio was 76%, greater in stage III group - 82% whereas in stage IV group 69%, but this difference was not statistically significant. All of the wounds healed up to 3 weeks, no complications were observed.Conclusion. The open fasciotomy is a recommendable short term treatment in patients of advanced age, suffering from stage III and stage IV of Dupuytren's disease.
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Osteomyoperiosteal Decortication Supplemented by Bony Transplants in the Treatment of Primarily Created Bony Defects of the Forearm Bones in Patients After Forearm Replantation

81%
Jabłecki J., Kaczmarzyk L., Domanasiewicz A., Kaczmapzyk J.
Polish Journal of Surgery
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2008
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vol. 80
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issue 2
69-74
EN
Amputation-type mutilation of forearm caused by crush or explosion mechanism result in bone defects of different size, which after successful replantation require filling by secondary reconstructive procedures.The aim of the study was presentation of the results of filling these defect by means oste-musculoperiosteal decortication with supplementation of cortico - canceleous bony transplants.Material and methods. From Jan. 1993 till Oct. 2006 14 men (mean age 31.3 y) were operated on for bone defects after 15.8 weeks on average. Defects of average size of 3.2 cm (range: 1.5 - 10 cm) were localized in shafts of forearm bones: radial bone (n=7), ulnar bone (n=4), both of the bones (n=3). The patients were free of any inflammatory process within the forearm. All patients had the osteosynthesis made by Rush pins (in 4 patients the previously made unstable osteosynthesis was removed and rush pins were inserted). Osteo-musculo-periosteal decortication of bony shafts was followed by implementation of bony transplants in subperiosteal space. These were bridging the defect. After operations the plaster cast was applied for 10.2 weeks on average.Results. X-ray control performed every 6 - weeks enabled the assessment of evolution of bony union within the defects. The final control was made 12 months after the operation. Healing of all of the wounds was uncomplicated. One patient was reoperated because of resorbtion of the bony transplants, but a proper bony union was achieved finaly after 15 weeks. In all of the other 13 patients the unification was achieved after 15.4 weeks on average (range from 14-18 weeks).Conclusion. Osteo-musculo-periosteal decortication is an effective method of filling the bony defects in patients after replantation of forearm.
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Surgical treatment of hemangiomas and arteriovenous malformations in upper extermity

81%
Jabłecki J., Elsaftawy A., Kaczmarzyk J., Kaczmarzyk L.
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vol. 85
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issue 3
107-113
EN
Hemangiomas belong to one of the most common type of tumors occurring in childhood. They are benign and often do not require any treatment, with the tendency to. frequently disappearing spontaneously at the age of 5-7 years. The tumors usually develop in the head and neck area, whereas vascular malformations (AVMs) are rare congenital anomalies, which may occur anywhere. In upper limb, they may amount to 30-60% of cases. It is common for these changes not to require any surgical treatment. In case they do, the main indications for such treatment of upper limb AVMs may be as follows: signs of compression of the peripheral nerves, limited mobility of the fingers because of the tumor, which entails difficulties in the functioning of the whole arm, pain and aesthetic considerations. Aim of the study was to present the results of surgical treatment of vascular tumors (hemangiomas and AVMs) in the upper limb that was applied in our department, as well as a broader discussion on epidemiology, diagnosis, and treatment of these changes. Material and methods. In 2003-2011 period we treated 11 patients aged 24-39, suffering from vascular tumors (hemangiomas / vascular malformations) in the upper limb; the group included 3 men and 8 women. In this group we diagnosed 2 cases with arm hemangiomas, 2 cases of intramuscular hemangiomas of the forearm, 2 cases of hemangiomas in metacarpal area, 2 cases of AVMs of the finger and metacarpal area, and 4 cases of isolated vascular malformations (mainly arteriovenous malformations) of the fingers. All preparations were examined histologically. Results. No complications or recurrence were found in 7 cases, recurrences of AVMs were observed in 4 patients with finger changes. In one patient with AVMs of the index finger, we observed a treble recurrence, which severely impaired functioning of his hand. We eventually suggested to him the finger amputation, to which the patient agreed Conclusions. Upper extremity is a rare location of hemangiomas and other vascular malformations requiring surgery. hemangiomas are more common in women, and the occurrence of AVMs in both males and females is similar. Surgical treatment of hemangiomas and AVMs of the upper extremities is doubtlessly an arduous task, which calls for great microsurgical skills.
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„Dangerous” Anatomic Varieties of Recurrent Motor Branch of Median Nerve

81%
Elsaftawy A., Gworys B., Jabłecki J., Szajerka T.
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vol. 85
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issue 8
419-423
EN
Carpal tunnel release became one of the most common operations in the field of hand surgery. Many controversies has been made about frequency of the so-called dangerous variations of motor branch of the median nerve. Knowledge of all the anatomical variations motor branches is the duty of every surgeon dealing with the subject. The aim of the study was to present the incidence of dangerous variants of median nerve motor branch in the carpal tunnel based on both clinical experience and anatomical studies performed on 20 cadaver wrists. Material and methods. Between 2006-2012 during minimally open carpal tunnel release we made photographic documentation of all visible dangerous varieties of recurrent motor branches of the median nerve. We also studied 20 cadaver wrists in the Department of Anatomy Medical University in Wrocław. Results. Dangerous varieties of the motor branch of median nerve was found in three clinical cases and in one cadaver wrist. Also In one wrist we found one regular branche, which, however, has atypical two separate branches supplying the thenar muscles. Conclusions. Dangerous varieties of the motor branch of median nerve occur very rare in the population, but does not release from the fact that in each case special attention must be given.We also conclude that, at the minimally open carpal tunnel release procedure, the transverse carpal ligament should be released rather from the line of radial border of the 4th finger to minimize the risk of injury to the recurrent motor branch of median nerve
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Hand Replantation in 83 Year Old Man - Case Report

81%
Kaczmarzyk L., Jabłecki J., Kaczmarzyk J.
Polish Journal of Surgery
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2009
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vol. 81
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issue 5
242-245
EN
Indications for hand replantation need to take into account the patients general condition and the severity of the trauma. The advanced age of the patient is generally considered as a limiting factor of the replantation but does not absolutely disqualify a patient.The case of a right - handed man, 83 years of age is presented, who had a circular- saw wrist level amputation of his dominant hand. As the general condition of the patient was satisfactory, the wound was clean, and the ischemia time was only 3 hrs the replantation of the hand was decided. The procedure was performed in a standardized way, the revascularization took place 7 hrs after injury. In the early post-operative period within the replanted part skin and soft tissue necrosis developed. It was treated with hyperbaric oxygen therapy, pediculed skin flap, and after its failure omental flap. The early functional result was poor (Chen's IV°). Patient died 27 weeks after replantation due to complications of coronaroplasty. The problems involved in replantation of hands of senile patients are discussed.
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Filling of Tissue Defects in the Hand With A Pediculed Osteocutaneous Groin Flap

81%
Jabłecki J., Kaczmarzyk L., Domanasiewicz A., Paruzel M.
Polish Journal of Surgery
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2009
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vol. 81
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issue 5
230-235
EN
The aim of the study was to evaluate the efficacy of pedicled osteocutaneous groin flaps in treatment of tissue defects of the hand.Material and methods. Twelve pedicled osteocutaneous groin flaps were used to fill bone defects of the hand in the same amount of patients (10 males and 2 females) aged 20-53 years (mean 33.4 years, SD 12 years). The defects affected metacarpal bones and wrist in 2 cases, metacarpus alone in 3 cases, fingers - in 4 (total amputations of 3 or 4 fingers), and thumb in 3 (total amputations). The osseous fragment measured from 6-18 ccm (mean 12.4 ccm). The osteosynthesis was performed using K-wires (10 patients) or AO headless cortical screw (2 patients). The flaps were detached gradually starting from postoperative day 18 with the final detachment performed on p.o. day 24-33 (mean 27.2 days, SD 6 days). Once after flap detachment the patients maintained the limb immobilized in a plaster cast for 5 weeks.Beside local abscess which was successfully treated with compresses, healing of the surgical site was uncomplicated. The bony union was assessed radiological and occurred after 9-13 weeks (mean 11.1 weeks, SD 5 weeks). Due to delayed bone union, one patient required bone slivers grafting which finally lead to unification. All the patients needed secondary plastic surgery of subcutaneous tissue of the flap; however, only 9 of them consented to it. In three patients we substituted the sensibility with a nerve graft according to Holevich.Results. The described operation did not improve function in patients with wrist-level and metacarpal osseous defects but improved its esthetical aspect; in the other patients the hand function was significantly restored.Conclusions. In patients disqualified for other methods of reconstructions of the thumb, fingers and bone defects of the hand a satisfactory result may be achieved by using pedicled osteocutaneous flaps from the iliac crest. This method proved to be highly effective.
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Management of Extensive or Infected Soft Tissue Defects in Upper Limb by Means of Pediculated Omental Flaps

81%
Domanasiewicz A., Kaczmarzyk L., Paruzel M., Jabłecki J.
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issue 11
503-511
EN
The basis for the treatment of deep tissue defects, particularly those that are infected, is coverage of the exposed anatomical structures with well vascularized tissues. To this end various kinds of vascularized-pedicled and free flaps are utilized. Post-trauma, soft tissue defects in the region of the upper extremity often involve areas of tissue poorly perfused, affected by necrosis and bacterial colonization. The size of the defect with accompanying intense purulence limits the application of local reconstruction and fasciocutaneal and muscle flaps. The greater omentum is one of the most promising and universal flaps on account of it's bactericidal and angiogenetic properties. The first report regarding a successful application of omentum in plastic surgery dates from 1965 year.The aim of the study was to present treatment results of extensive as well as infected tissue defects of upper limb with the application of pedicled omental flaps in material from Sub-Department of Limb Replantation in Trzebnica.Material and methods. Between 2005-2009 in the St. Hedwig's Hospital 35 patients (30 M, 5 F) avg age 38.3 (range 10-73) were treated using omentum flaps. The causes of defects were primarily crush injuries (13), burn wounds (2), secondary necrosis of replanted/revascularized limb tissues (14) including chronic bone infections, contaminated degloving injuries of upper limb (4). The area of tissue defect amounted to avg 84 cm2 (range 25-227 cm2)Most of this, 31/35 (89%) posed infected wounds (Staphylococcus aureus 11, Escherichia coli 12, Enterococcus faecalis 11, Staphylococcus coagulsonegative 10, Pseudomonas aeruginosa 5, Acinetobacter baumanii 6, Proteus mirabilis 6, Enterobacter cloacae 4). The procedure was based on covering of the defects with pedicled omental flap obtained during epigastric laparotomy, with split- thikness skin graft. After the procedure apart from the surgical prophylaxis general antiobtic therapy was not applied, nor locally. After 3-4 weeks the pedicle of flap was cuted and it's appearance was modeled as well as covered using skin graft.Results. Complete healing with good fuctional and cosmetic results was achieved in 32/35 cases, after transplantation of omentum in 52% of wounds a change in bacterial flora was observed to saprofitic and antibiotic-sensitive, and in 38% donor site was aseptic. Cultures were attained, in the remainder signs of infection receded despite the presence of pathological flora. In 2 cases complete or partial necrosis of flap was observed, in one the vital flap was removed due to amputation of limb (crush syndrome). Complication in the form of hernia were observed in 5/35 patients, however no complaints of abdominal pain or abscess of space drawing.Conclusions. Free and pedicled omental flaps appear to be the ideal solution in the treatment of tissue defects and bone infections chronically infected with antibiotic-resistant cultures. The omentum also is a appropriate material for covering of fresh defects with exposed ligaments, nerves and bones. The complications at the obtaining site in our material occured rarely when compared to the available published data. Currently it is possible also to harvest the omentum laparoscopically.
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Three-Year Activity Report of the Replantation Service for Amputation of the Hand in Poland

81%
Żyluk A., Jabłecki J., Romanowski L., Mazur A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 11
574-581
EN
A permanent on-call service for hand amputation (Replantation Service) was established in 2010 as the initiative of the Council of Polish Society for Surgery of the Hand. It is run by three qualified hand centres in Trzebnica, Poznań and Szczecin. The aim of the study was to present a summary of the almost three-year activity of this service. Material and methods. Over this period, a total of 435 cases of total amputations, subtotal amputations and other severe injuries to the hand were referred. Of these, 290 referrals (67%) were accepted and 141 (33%) rejected. Among accepted, there were 100 total (34%) and 113 subtotal (39%) amputations; 81 patients had other, severe hand injuries, such as crush, degloving and extensive wounds involving all tissues. Results. Young and middle-age males constituted the majority of patients with the mean age of 42 years (range 2-82). The most common injury was amputation of several digits (including thumbs) in one patient - 141 cases (48%), followed by amputations from the metacarpal- to the proximal forearm level -115 (39%) and elbow/arm level - 9 cases (3%). Niniteen patients (6%) had multi-level amputation or injury of the involved extremity. Replantation of the completely amputated extremity was performed in 83 patients (28%), revascularization in 95 (32%) and in 59 (20%) primary repair of the complex injuries. In 23 cases, the repair of tissue defects was performed with flaps, mostly with greater omentum. Survival rate was of 84% for replantations and 88% for revascularizations. Conclusion. Establishing of the Replantation Service constituted a significant progress in organization of the management of the most severest upper limb injuries.
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Problems Associated with Forearm Reimplantation

71%
Jabłecki J., Kaczmarzyk J., Kaczmarzyk L., Domanasiewicz A., Kocięba R.
Polish Journal of Surgery
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2007
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vol. 79
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issue 2
70-77
EN
The aim of the study was to present the technical and qualification problems associated with forearm reimplantation.Material and methods. The analysed group included 29 patients, 25 male and 4 female, who had in the period of 10 years (between January 1994 and December 2003) undergone 10 reimplantations and 19 revascularisations (partial amputation) of the forearm. The age of the patients ranged from 19 to 63 years. Due to massive limb destruction, 8 patients only underwent wound revision. The number of operations performed within the 4 distinct zones of the forearm was as follows: I - 8 patients, II - 17, III - 3, IV - 1; 20 (69%) of cases were the result of crush-avulsion injuries. The bones were stabilised by means of intramedullary nails, muscle bellies were sutured with mattress sutures, and the torn-off tendons were reinserted to the bellies by Chen's method. We attempted anastomosis of two main forearm arteries and the greatest possible number of veins, and a vein graft was applied in 2 cases. The operative wound was closed with skin graft in 4 patients.Results. There were 5 failures (17.2%). Nine patients required secondary reconstructive procedures for bone issues, 4 patients for nerves, and 3 for tendons. The operations were performed between 20 to 29 months after the reimplantation. The functional results were assessed according to Chen's scheme. 2 patients achieved grade I, 9 grade II, 13 grade III, and 5 grade IV. Two patients, the farmers, regained their previous profession. All of the patients were satisfied with regaining the limb.Conclusions. Problems encountered in forearm reimplantation are due to unfavorable mechanisms of trauma. The technical aspects of such surgeries require a highly qualified surgical team. The prognosis for survival and functional recovery is lower in proximal as compared to distal injuries.
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Treatment possibilities of reverse-flow sural flap in covering the defects of lower extremities

62%
Elsaftawy A., Jabłecki J., Domanasiewicz A., Paruzel M., Kaczmarzyk J., Kaczmarzyk L.
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vol. 85
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issue 4
192-197
EN
Soft tissue defects of the lower extremity pose an important surgical challenge, often because of inviability of primary covering. Therapeutic modalities of choice comprise of local perforator flaps, as well as of free flaps created with the use of microsurgical skills. However, these methods cannot be applied in patients with important comorbidities, and it is in such cases where the reverse sural flap proves to be the best solution. The aim of the study was to present the results of treating lower extremity defects with various modifications of the reverse sural flap. Material and methods. Sixteen patients, males aged 17-56 years, were operated on from 2007 to 2013. Diabetes with multiple complications, disseminated atheromatosis, and extensive soft tissue trauma involving the arteries crucial for microsurgica anastomoses were the most common reason disqualifying from the free and perforator-based flap techniques. Results. All of the patients achieved very good results; in two cases distal and marginal flap necrosis was observed which, once exiced, covered with granulation, and was successfully covered with a partialthickness skin graft. Conclusions. The reverse sural flap, technically easy, offers a viable, low-risk alternative to free and perforator-based flaps.
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First Polish Hand Allograft - 6-Month Report

62%
Jabłecki J., Kaczmarzyk L., Patrzałek D., Domanasiewicz A., Paruzel M., Chełmoński A., Kaczmarzyk J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 3
232-238
EN
The transplant recipient is a 32 year-old man who lost his right, dominant upper limb on the level of the midpoint of his forearm in an accident 14 years ago. After a comprehensive pretransplantation evaluation and informed consent process he received a transplant of the right forearm, matched for size and skin tone, of a brain-dead man aged 47. The donor's limb was amputated at the elbow and irrigated with UW solution. We dissected the donor and recepient limbs simultaneously. Appropriate lengths of anatomical structures were matched. Bone fixation was performed with Rush pins, without bony transplants; the muscles were anastomosed in layers and the skin wound was closed without a skin transplant. The cold ischemia time was 10.5 hours. Immunosuppresion included simulect, tacrolimus, mycophenolic acid, and prednisone. Maintanance therapy included tacrolimus (15 ng/ml), mycophenolic acid, and encorton.There were no intraoperative or early postoperative complications. No episodes of rejection were observed. Immunosupression was well tolerated. The intensive physiotherapy led to satisfactory progress of motor function recovery. Reinnervation was excellent, and after 6 months, Tinel's sign was present over 40% of the respective lengths of the median and ulnar nerves. Follow-up included routine post-transplant laboratory tests, skin biopsies, bacteriological tests, and physiotherapy.
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