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Cortical Motor Activation Patterns Following Hand Transplantation and Replantation

From the Clinical Departments of Neurology, Radiology, Traumatology, Plastic and Reconstructive Surgery, Ludwig-Boltzman-Institute of Quality Control in Plastic Surgery and Department of Transplant Surgery, Innsbruck Medical University, Austria

Correspondence: Dr Christian Brenneis, MD, Clinical Department of Neurology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria, Tel.: +43 512 504 0; Fax: +43 512 504 3852. E-mail: christian.brenneis{at}uibk.ac.at (C. Brenneis).

We studied cortical activation patterns by functional MRI in a patient who received bilateral hand transplantation after amputation 6 years ago and in a patient who had received unilateral hand replantation within 2 hours after amputation. In the early postoperative period, the patient who had had the hand transplantation revealed strong activation of a higher motor area, only weak activation of the primary sensorimotor motor cortex and no activation of the primary somatosensory cortex. At 1-year follow-up, a small increase in primary sensorimotor motor cortex activation was observed. Activation of the primary somatosensory cortex was only seen at the 2 year follow-up. By contrast, after hand replantation, the activation pattern was similar to that of the uninjured hand within 6 weeks. This included activation of the primary sensorimotor motor cortex, higher motor areas and primary somatosensory cortex. Transplantation after long-standing amputation results in cortical reorganization occurring over a 2-year period. In contrast, hand replantation within a few hours preserves a normal activation pattern.

Key Words: hand transplantation • replantation • cortical reorganization • motor recovery • fMRI

Journal of Hand Surgery (British and European Volume), Vol. 30, No. 5, 530-533 (2005)
DOI: 10.1016/j.jhsb.2005.05.012


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