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Facial composite tissue transplant

Bowen Gao, Qingxiong Yu, Feng Xie, Lingling Sheng, Xiyuan Mao, Qingfeng Li, Hainan Zhu
BACKGROUND: Conventional reconstructive methods fail to achieve satisfactory results in total eyelid defect cases. Vascularized composite tissue allotransplantation might provide both good appearance and function for these patients. The structure of the eyelid is exceptional because it simultaneously consists of skin, connective tissue, the striated muscle, fiber structure, aponeuroses, and mucosa. Thus, before clinical application of eyelid allotransplantation, more experiments are needed to clarify the impact of ischemia, immunal suppressive agents, and deinnervation effects on these sophisticated structures...
October 13, 2016: Ophthalmic Plastic and Reconstructive Surgery
H Jiang, A T Liu
Postburn facial scar contracture, which can cause disfigurement and functional impairment, is a major therapeutic challenge. Except for some scars with severe functional impairments such as ectropion of lid, obstruction of nostril, microstomia, and so on, other kinds of facial scars are recommended to be reconstructed after they become sufficiently softened. The selection of specific methods depends on the characteristics of the facial scar. The methods includ direct closure after resection, full or split-thickness skin transplantation, pedicled flap, distant flap, and free flap transfer, and tissue expansion...
August 20, 2016: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Edward H Davidson, Eric W Wang, Jenny Y Yu, Juan C Fernandez-Miranda, Dawn J Wang, Yang Li, Maxine Miller, Wesley N Sivak, Debra Bourne, Hongkun Wang, Mario G Solari, Joel S Schuman, Kia M Washington
Vascularized composite allotransplantation represents a potential shift in approaches to reconstruction of complex defects resulting from congenital differences as well as trauma and other acquired pathology. Given the highly specialized function of the eye and its unique anatomical components, vascularized composite allotransplantation of the eye is an appealing method for restoration, replacement, and reconstruction of the nonfunctioning eye. Herein, we describe conventional treatments for eye restoration and their shortcomings as well as recent research and events that have brought eye transplantation closer to a potential clinical reality...
October 2016: Journal of Craniofacial Surgery
Michael Sosin, Daniel J Ceradini, Jamie P Levine, Alexes Hazen, David A Staffenberg, Pierre B Saadeh, Roberto L Flores, Nicole G Sweeney, G Leslie Bernstein, Eduardo D Rodriguez
BACKGROUND: Reconstruction of extensive facial and scalp burns can be increasingly challenging, especially in patients that have undergone multiple procedures with less than ideal outcomes resulting in restricting neck and oral contractures, eyelid dysfunction, and suboptimal aesthetic appearance. METHODS: To establish a reconstructive solution for this challenging deformity, a multidisciplinary team was assembled to develop the foundation to a facial vascularized composite allotransplantation program...
July 2016: Plastic and Reconstructive Surgery
Bernard L Devauchelle, Sylvie R Testelin, Julien Davrou, Cécilia Neiva, Benoît G Lengele, Jean-Michel Dubernard, Stéphanie Dakpe
The possibility to imagine a vascularized composite allotransplantation for disfigured children is felt more critical than for adults non on technical point of view but in terms of indications and justifications. The question is not about surgery. It is related to the pathologies themselves for which transplant could be suitable. Moreover the procurement of face transplant will be more difficult because of immunologic criteria but also age and phototype. Specificity of the newborn malformative face is usually not only a question of tissue defect...
August 2016: Journal of Cranio-maxillo-facial Surgery
Michael Sosin, Daniel J Ceradini, Alexes Hazen, Jamie P Levine, David A Staffenberg, Pierre B Saadeh, Roberto L Flores, Lawrence E Brecht, G Leslie Bernstein, Eduardo D Rodriguez
BACKGROUND: The application of aesthetic, craniofacial, and microsurgical principles in the execution of face transplantation may improve outcomes. Optimal soft-tissue face transplantation can be achieved by incorporating subunit facial skeletal replacement and subsequent tissue resuspension. The purpose of this study was to establish a reconstructive solution for a full face and scalp burn and to evaluate outcome precision and consistency. METHODS: Seven mock face transplants (14 cadavers) were completed in the span of 1 year...
May 2016: Plastic and Reconstructive Surgery
Yalcin Kulahci, Selman H Altuntas, Huseyin Karagoz, Joanna M Cwykiel, Fatih Zor, Maria Siemionow
INTRODUCTION: Vascularized composite allotransplantation (VCA), a new reconstructive option for patients suffering from extensive facial defects leads to superior functional and aesthetic outcomes compared to the standard autologous reconstruction. Among VCA recipients, each case involves different facial structures and tissues depending on the patient's injury, thus drawing conclusions on the mechanism of immune interactions between the donor and recipient is challenging. This study introduces a new total hemiface VCA model, including scalp, external ear, mystacial pad, premaxilla, upper/lower lids, nose, and upper/lower lips to evaluate the effect of transplantation of multitissue VCA on the recipient's immune response...
March 2016: Microsurgery
M Kueckelhaus, M Turk, K K Kumamaru, L Wo, E M Bueno, C G Lian, M Alhefzi, M A Aycart, S Fischer, U De Girolami, G F Murphy, F J Rybicki, B Pomahac
Facial allotransplantation restores normal anatomy to severely disfigured faces. Although >30 such operations performed worldwide have yielded promising short-term results, data on long-term outcomes remain scarce. Three full-face transplant recipients were followed for 40 months. Severe changes in volume and composition of the facial allografts were noted. Data from computed tomography performed 6, 18 and 36 months after transplantation were processed to separate allograft from recipient tissues and further into bone, fat and nonfat soft tissues...
March 2016: American Journal of Transplantation
Jean Kanitakis, Palmina Petruzzo, Aram Gazarian, Sylvie Testelin, Bernard Devauchelle, Lionel Badet, Jean-Michel Dubernard, Emmanuel Morelon
Recipients of solid organ transplants (RSOT) have a highly increased risk for developing cutaneous premalignant and malignant lesions, favored by the lifelong immunosuppression. Vascularized composite tissue allografts (VCA) have been introduced recently, and relevant data are sparse. Two patients with skin cancers (one with basal cell carcinoma and one with squamous cell carcinomas) have been so far reported in this patient group. Since 2000 we have been following 9 recipients of VCA (3 face, 6 bilateral hands) for the development of rejection and complications of the immunosuppressive treatment...
2015: Case Reports in Transplantation
Christina R Vargas, John T Nguyen, Yoshitomo Ashitate, Joseph Angelo, Vivek Venugopal, Frank Kettenring, Florin Neacsu, John V Frangioni, Sylvain Gioux, Bernard T Lee
BACKGROUND: Vascularized composite allotransplantation represents an important advancement in the field of reconstructive microsurgery and has continued to increase in popularity. The significant clinical morbidity associated with flap failure represents an important barrier to even more widespread use of these techniques. Early identification of vascular compromise has been associated with a higher salvage rate, yet most surgeons rely only on clinical assessment intraoperatively. Spatial frequency domain imaging (SFDI) presents a noncontact, objective measurement of tissue oxygenation over a large field of view...
February 2016: Annals of Plastic Surgery
M Iglesias, P Butrón, A I Osuna-Leal, L Abarca-Perez, M J Sosa-Ascencio, M A Moran-Romero, A U Cruz-Reyes, F J Pineda-Gutierrez, D A Leon-Lopez, M N García-Alvarez, J Alberu, M Vilatoba, R P Leal-Villalpando, J Zamudio-Bautista, V M Acosta-Nava, J Gonzalez
With the limitations of surgical reconstructive procedures, the growing number of gunshot wounds, burns, and work accidents in Mexico that result in complex facial deformities leaves only 1 option-face transplantation. The National Institute of Medical Sciences and Nutrition "Salvador Zubiran" (INCMNSZ) has performed transplants since 1971. We at INCMNSZ undertook the 1st bilateral upper-limb transplantation in Latin America in 2012. We are willing to continue in this manner toward conducting face transplantation at our institute...
July 2015: Transplantation Proceedings
Jeffrey E Janis, Ibrahim Khansa, Craig R Lehrman, Dennis P Orgill, Bohdan Pomahac
BACKGROUND: Devastating fourth-degree electrical injuries to the face and head pose significant reconstructive challenges. To date, there have been few peer-reviewed articles in the literature that describe those reconstructive challenges. The authors present the largest case series to date that describes the management of these injuries, including the incorporation of face transplantation. METHODS: A retrospective case series was conducted of patients with devastating electrical injuries to the face who were managed at two level-1 trauma centers between 2007 and 2011...
October 2015: Plastic and Reconstructive Surgery
N A Roche, P N Blondeel, K M Van Lierde, H F Vermeersch
BACKGROUND: Composite tissue allografting (CTA) represents the essence of reconstructive surgery, combining principles of solid organ transplantation (SOT) and modern plastic surgery techniques. The purpose of this article is to give a review of the history of facial CTA and an update of the cases that have been operated so far worldwide. METHODS: A systematic review of the medical literature was performed. Ten relevant publications were selected and analyzed for clinical data of the patients, surgical aspects of transplantation, complications and outcome...
March 2015: Acta Chirurgica Belgica
Marcelo Coelho Goiato, Daniela Micheline Dos Santos, Lisiane Cristina Bannwart, Marcela Filié Haddad, Leonardo Viana Pereira, Aljomar José Vechiato Filho
Several factors including cancer, malformations and traumas may cause large facial mutilation. These functional and aesthetic deformities negatively affect the psychological perspectives and quality of life of the mutilated patient. Conventional treatments are prone to fail aesthetically and functionally. The recent introduction of the composite tissue allotransplantation (CTA), which uses transplanted facial tissues of healthy donors to recover the damaged or non-existent facial tissue of mutilated patients, resulted in greater clinical results...
November 2014: Journal of Dentistry of Tehran University of Medical Sciences
Nathalie A Roche, Hubert F Vermeersch, Filip B Stillaert, Kevin T Peters, Jan De Cubber, Kristiane Van Lierde, Xavier Rogiers, Luc Colenbie, Patrick C Peeters, Gilbert M D Lemmens, Phillip N Blondeel
INTRODUCTION: Complex injuries to the central part of the face are difficult to reconstruct with the current plastic surgery methods. The ultimate one-staged approach to restore anatomy and vital facial functions is to perform a vascularized composite allotransplantation (VCA). METHODS: A 54-year-old man suffered from a high-energy ballistic injury, resulting in a large central facial defect. A temporary reconstruction was performed with a free plicated anterolateral thigh (ALT) flap...
March 2015: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Raja Mohan, Mark Fisher, Amir Dorafshar, Michael Sosin, Branko Bojovic, Dheeraj Gandhi, Nicholas Iliff, Eduardo D Rodriguez
BACKGROUND: Over the past decade, facial vascularized composite allotransplantation has earned its place at the top of the reconstructive ladder. However, as in free tissue transfer, postoperative revisions are necessary to achieve optimal functional and aesthetic results. Although revising a facial vascularized composite allotransplantation may potentially risk the integrity of the graft, the authors believe that the advantages of appropriately chosen revisions may provide great benefit...
December 2014: Plastic and Reconstructive Surgery
Prabha Yadav
Treatment of cancer is race against time! Following radical excision, breathing, speech, mastication and swallowing are hampered. Face is invariably involved. Beside functional normalcy, excellent cosmetic restoration is necessary for patient's life quality. Primary wound healing, quick resumption of adequate oral intake, prompt initiation of chemo-radiotherapy has direct bearing on cure. Primary reconstruction with pedicle or free flap is the choice of treatment in most protocols. Composite defects are requiring bone, muscle and skin restrict choice of donor site and may have shortfalls in aesthetic and functional requirements...
May 2014: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Gaby Doumit, Bahar Bassiri Gharb, Antonio Rampazzo, Francis Papay, Maria Z Siemionow, James E Zins
BACKGROUND: Vascularized composite allotransplantation (VCA) has experienced a growing acceptance, which has led to a debate centered on extending the indications of the procedure to include pediatric patients. The aim of this article was to discuss such indications based on the evidence in pediatric solid organ transplantation, reconstructive surgery in children, and VCA in adult patients. METHODS: Papers published on the outcomes of pediatric solid organ transplantation, growth after replantation of extremities, vascularized autologous tissue transfer, craniofacial surgery, orthognathic procedures, facial fractures, and outcomes after repair of peripheral nerves in children were reviewed...
October 2014: Annals of Plastic Surgery
David W Mathes, James A Edwards, Yoshimi Anzai, Peter C Neligan
BACKGROUND: Injury to the face can result in the loss of critical specialized structures (the eyelids, lips, ears and nose). Vascularized composite allotransplantation (VCA) allows the surgeon to replace exactly what has been lost. The success of the clinical face transplants suggests the possibility of transplanting specialized units of the face. In this study we explore the neurovascular anatomy and technical specifics for harvest of a functional composite eyelid subunit flap. METHODS: 12 fresh cadaver heads were studied, each yielding two flaps (N = 24)...
October 2014: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Raja Mohan, Daniel E Borsuk, Amir H Dorafshar, Howard D Wang, Branko Bojovic, Michael R Christy, Eduardo D Rodriguez
BACKGROUND: As of July of 2013, 27 facial vascularized composite allotransplantations have been performed. The authors developed a classification system and treatment algorithm that is practical and surgically applicable. METHODS: The majority of the transplants have been described in the surgical literature and the media, and a review of the data was performed. A classification system and a treatment algorithm were designed. Skeletal defects were defined by craniofacial osteotomies and soft-tissue defects by aesthetic facial subunits...
February 2014: Plastic and Reconstructive Surgery
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