Vascularized composite allograft aims to restore the function of the limb and its appearance and is reserved in France for bilateral traumatic amputees. Functional recovery after upper limb allotransplantation remains a challenge, especially when the amputation is proximal. The case presented is a 48-year-old man who underwent bilateral amputation following an electrical burn in 1998. He had received a liver transplant in 2002 for which he was receiving immunosuppressive treatment. The patient was using a mechanical prosthesis on the right side and a cosmetic prosthesis on the left side but remained unsatisfied.

On the right side, the donor humerus was fixed on the remaining 9-cm-long proximal stump, and was reinforced with the donor fibula in an intramedullary fashion. On the left side, the whole donor humerus (including the humeral head) was transplanted with reconstruction of the gleno-humeral joint, including a suspension ligamentoplasty. Arteries and veins were anastomosed at the axillary and sub-clavian levels. The brachial plexus was sutured at the cords level on the left side and at the proximal peripheral nerves on the right side. Cold ischemia times were 46 min on the right side and 47min on the left side. Rehabilitation began on Day 1 and included lymphatic drainage and passive mobilizations, followed by electrostimulation, psychomotricity and sensory-motor stimulation.

Regarding the results, motor recovery was detectable since 6 months post-surgery in the deltoids, biceps and triceps bilaterally. Sensitive recovery was already perceptible at 8 months. The patient has a two-points discrimination of 15 mm both thumbs. Functionally, the preoperative Functional Independence Measure was 93/126 and is 121/126 at 36 months post-surgery. The DASH score was measured at 50.8 at three years, compared to 66 preoperatively. The patient is satisfied with his autonomy in some daily activities, but his greatest satisfaction is the recovery of his body image. The HTSS score is 63.5 (good) on the right side and 60.5 (fair) on the left side. Since the surgery, the patient developed 5 episodes of acute rejections treated by intravenous corticosteroids.

For this patient whose main request was the restoration of body image, the sensitive, motor and functional results are promising. These results are consistent with the few cases described in the literature.

The quality of the results observed at 3 years invites to propose the procedure to a bilateral and proximal arm amputed patient without pre-existing anti-rejection treatment who accepts the limits and risks of this treatment.