Toon Lenaerts May 17, 2016

Nothing like this had ever been done before, and Dr. Sides was skeptical at first. But with the feeling that some ideas are so crazy they just might work, Dr. Sides approached a former colleague, Dr. Lisa Lattanza, the Chief of Elbow and Upper Extremity Surgery at UCSF in San Francisco, to see if the idea was possible. Dr. Lattanza knew that although an elbow-to-elbow transplant had never been done before, the component parts (vascular anastomosis, large bone transport, tendon reconstruction and osteotomy) had been done individually with success. She approached Materialise to help plan the patient’s elbow transplant in 3D.

Materialise Clinical Engineer Alyssa Ricker played a key part in helping Dr. Lattanza to visualize the patient’s pre-operative anatomy and strategize the correction. What made Reggie’s case particularly unique was the fact that his surgeons had to transplant anatomy that was a mirror image of his damaged side. Starting from CT scans of the patient’s arms, Alyssa reconstructed the bones in Materialise Mimics, and worked together with Dr. Lattanza to assess the potential risks involved in the elbow transplant as well as planning out a course of action for the surgery.

elbow transplant
Preparing a ground-breaking elbow transplant: pre-operative situation (left) and surgical outcome (right)

The surgery lasted a grueling total of 11 hours, with two teams working together to carefully preserve the muscle tissue, nerves and blood vessels surrounding both elbows. The 3D-printed bone models of the humerus, radius and ulna were used intra-operatively to verify cuts around the elbow and the positioning of the transplant elbow, confirming the plan first with the models before transferring it to the patient. The bones, arteries, veins, tendon, ligaments and joint (as composite tissue) of the left elbow were then transplanted to the right side. The humerus bones were affixed with an intramedullary rod and the ulnas were plated together. The microvascular anastomosis was then performed, hooking vessels from the left arm to the flowing arteries of the right side. Without this blood supply the transplant would not have been viable. The tendons were then reconstructed so that the patient would be able to move the new elbow. The surgery was finished, making it a milestone for the medical industry as it was the first of its kind.

elbow transplant post-op result
Reginald Cook rests his arm, which features an elbow transplanted from his left arm, on pillows at UCSF Medical Center. ©Leah Millis ©Leah Millis

Although it is too early to tell the precise results of the surgery, the first post-operative signs are encouraging as Reggie is able to move his fingers and the blood flow in his right arm remains normal. He can now bring his hand to his face and mouth for the first time in many years. Hopefully he will be able to regain almost complete use of his arm once the tendons heal, giving him the independence he so sorely missed after his car accident.

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