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Vascularized composite allotransplantation

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https://www.readbyqxmd.com/read/29746324/extracorporeal-perfusion-in-vascularized-composite-allotransplantation-current-concepts-and-future-prospects
#1
Maximilian Kueckelhaus, Flemming Puscz, Alexander Dermietzel, Mehran Dadras, Sebastian Fischer, Nicco Krezdorn, Bohdan Pomahac, Tobias Hirsch
Severe injuries of the face and limbs remain a major challenge in today's reconstructive surgery. Vascularized composite allotransplantation (VCA) has emerged as a promising approach to restore these defects. Yet, there are major obstacles preventing VCA from broad clinical application. Two key restrictions are (1) the graft's limited possible ischemia time, keeping the potential donor radius extremely small, and (2) the graft's immunogenicity, making extensive lifelong monitoring and immunosuppressive treatment mandatory...
June 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29723921/de-novo-belatacept-in-clinical-vascularized-composite-allotransplantation
#2
Linda C Cendales, David S Ruch, Adela R Cardones, Guy Potter, Joshua Dooley J, Daniel Dore, Jonah Orr, Gregory Ruskin, Minqing Song, Dong-Feng Chen, Maria A Selim, Allan D Kirk
Most immunosuppressive regimens used in clinical vascularized composite allotransplantation (VCA) have been calcineurin inhibitor (CNI)-based. As such, most recipients have experienced CNI-related side effects. Costimulation blockade, specifically CD28/B7 inhibition with belatacept, has emerged as a clinical replacement for CNI-based immunosuppression in kidney transplantation. We have previously shown that belatacept can be used as a centerpiece immunosuppressant for VCA in non-human primates, and subsequently reported successful conversion from a CNI-based regimen to a belatacept-based regimen after clinical hand transplantation...
May 3, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29704864/from-autotransplantation-to-allotransplantation-a-perspective-on-the-future-of-reconstructive-microsurgery
#3
L Scott Levin
It has been half a century since Susumu Tamai reported on the first thumb replantation. The evolution of reconstructive microsurgery has continually added new applications of the operating microscope for reconstructive surgery and has had profound impact on countless patients. From the time of Harold Gillies until today, the reconstructive ladder has evolved to a reconstructive elevator with the "penthouse" floor being represented by vascularized composite allotransplantation.
April 28, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29620616/meeting-report-of-the-13th-congress-of-the-international-society-of-vascularized-composite-allotransplantation
#4
Annemarie Weissenbacher, Linda Cendales, Emmanuel Morelon, Palmina Petruzzo, Gerald Brandacher, Peter J Friend, Vijay Gorantla, Christina Kaufman, Johanna Krapf, Lawrence Scott Levin, Georgios Vrakas, Stefan Schneeberger
The International Society of Vascularized Composite Allotransplantation (ISVCA) held its 13th congress "Defining Success" in October 2017 in Salzburg, Austria. A total of 122 delegates from 22 countries representing 5 continents attended the conference. The theme strived to provide pathways to accomplish best possible outcomes in this unique and multifaceted field of transplantation. 'Ignite talks', a new feature introduced for the first time at the Salzburg meeting served as key elements for productive discussions on both congress days...
April 3, 2018: Transplantation
https://www.readbyqxmd.com/read/29595735/a-new-composite-eyeball-periorbital-transplantation-model-in-humans-an-anatomical-study-in-preparation-for-eyeball-transplantation
#5
Maria Siemionow, Mehmet Bozkurt, Fatih Zor, Yalcin Kulahci, Safak Uygur, Can Ozturk, Risal Djohan, Frank Papay
BACKGROUND: Vascularized composite allotransplantation offers a new hope for restoration of orbital content and perhaps vision. The aim of this study was to introduce a new composite eyeball-periorbital transplantation model in fresh cadavers in preparation for composite eyeball allotransplantation in humans. METHODS: The composite eyeball-periorbital transplantation flap borders included the inferior border, outlined by the infraorbital rim; the medial border, created by the nasal dorsum; the lateral border, created by the lateral orbital rim; and the superior border, created by the superior part of the eyebrow...
April 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29561493/lacrimal-apparatus-procurement-in-face-transplantation
#6
Asif Hasan, Colin Maciver, Gaoussou Toure, Jean-Paul Meningaud
The aesthetic outcome of a well-planned and executed vascularized composite tissue face allotransplant is unquestionable; however, complete functional restoration is necessary. The authors studied the possibility of restoring tear duct function in face transplant recipients. They also examined the technical specifics and feasibility of incorporating a lacrimal drainage apparatus into facial allografting. The authors performed a standardized face vascularized composite allograft on 4 hemi-faces (2 fresh cadavers)...
March 20, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29504151/bone-vascularized-composite-allotransplantation-model-in-swine-tibial-defect-evaluation-of-surgical-angiogenesis-and-transplant-viability
#7
Dimitra Kotsougiani, Caroline A Hundepool, Liselotte F Bulstra, Patricia F Friedrich, Alexander Y Shin, Allen T Bishop
INTRODUCTION: In prior small animal studies, we maintained vascularized bone allotransplant viability without long-term immunotherapy. Instead, an autogenous neoangiogenic circulation is created from implanted vessels, sufficient to maintain bone viability with only 2 weeks immunosupression. Blood flow is maintained despite rejection of the allogeneic vascular pedicle thereafter. We have previously described a large animal (swine) pre-clinical model, reconstructing tibial defects with vascularized tibial allotransplants...
March 5, 2018: Microsurgery
https://www.readbyqxmd.com/read/29498981/anatomic-considerations-for-temporomandibular-joint-vascularized-composite-allotransplantation
#8
Nima Khavanin, Edward H Davidson, Diana Y Lee, Patrick Byrne, Amir H Dorafshar
Concomitant temporomandibular joint (TMJ) transplantation is an obvious advancement in the reconstructive armamentarium for face transplantation in scenarios involving TMJ ankylosis. This study investigates the fidelity of mandibular morphology and explores the feasibility of bilateral mandibular condyle transfer in facial vascularized composite allotransplantation. Geometric analysis was performed on 100 skeletally mature maxillofacial computed tomography scans. Exclusion criteria included mandibular trauma and dentoalveolar disease...
March 1, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29489486/achievements-and-challenges-in-facial-transplantation
#9
William J Rifkin, Joshua A David, Natalie M Plana, Rami S Kantar, J Rodrigo Diaz-Siso, Bruce E Gelb, Daniel J Ceradini, Eduardo D Rodriguez
: The first facial transplantation in 2005 ushered in a new era in reconstructive surgery, offering new possibilities for the repair of severe disfigurements previously limited by conventional techniques. Advances in allograft design, computerized preoperative planning, surgical technique, and postoperative revisions have helped push the boundaries in this new frontier of vascularized composite allotransplantation. Over the past 12 years, 40 of these procedures have been performed across the world, offering the field the opportunity to reflect on current outcomes...
February 27, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29464206/improved-cuff-technique-and-intraoperative-detection-of-vascular-complications-for-hind-limb-transplantation-in-mice
#10
Minhyung Kim, Daniel T Fisher, Colin A Powers, Elizabeth A Repasky, Joseph J Skitzki
Background: Vascularized composite tissue allotransplantation (VCA) from a cadaveric donor has now become a clinical reality and the treatment modality of choice for patients with devastating injuries, deformities, and complex tissue defects. However, many VCA patients experience severe toxicities due to the strong immunosuppression required secondary to high antigenicity of the grafts. To improve immunosuppressive protocols for VCA, feasible and reliable preclinical models are necessary...
February 2018: Transplantation Direct
https://www.readbyqxmd.com/read/29441355/eponychial-lesions-following-bilateral-upper-extremity-vascular-composite-allotransplantation-a-case-report
#11
Fedra Fallahian, David Molway, Saagar Jadeja, Rachael Clark, Francisco M Marty, Leonardo V Riella, Anil Chandraker, Simon G Talbot
Vascularized composite allotransplantation represents a useful addition to reconstructive options available to the plastic surgeon. Though the procedure provides beneficial functional outcomes, there remain complications, often associated with the immunosuppression necessary to maintain an allograft. We report a case of eponychial fold lesions following successful bilateral upper extremity allotransplantation.
2018: Case Reports in Plastic Surgery & Hand Surgery
https://www.readbyqxmd.com/read/29441177/anesthetic-management-of-the-first-forearm-transplantation-in-korea
#12
Jinyeol Kwon, Sung Mee Jung, Sae-Yeon Kim, Nyeong Keon Kwon, Sang-Jin Park
Vascularized composite allotransplantation for the forearm is a complex surgical procedure, requiring multidisciplinary collaboration. It is important to provide optimal blood flow to the grafts, effective immunosuppression, and early rehabilitation for graft survival and good functional outcomes. As ischemia-reperfusion injury and substantial but unquantifiable blood loss are inevitable in this type of surgery, anesthetic management should focus on providing adequate hemodynamic management with proper monitoring, and anesthetic and analgesic strategies to prevent vasoconstriction in the graft...
February 2018: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/29363357/clinical-application-of-mathematical-long-bone-ratios-to-calculate-appropriate-donor-limb-lengths-in-bilateral-upper-limb-transplantation
#13
Justyn Lutfy, Alexis Pietak, Shaun D Mendenhall, Michael W Neumeister
BACKGROUND: Limited methods exist to aid in deciding the appropriate donor limb lengths in bilateral upper limb amputees qualifying for vascularized composite allotransplantation. We hypothesized mathematical equations could be created using long bone length ratios, and applied to radiographs, to approximate the patient's limb length prior to amputation. METHODS: A data set of 30 skeletons' unilateral upper limb long bones measured using osteometric board and calipers was used...
January 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/29343892/first-two-bilateral-hand-transplantations-in-india-part-4-immediate-post-operative-care-immunosuppression-protocol-and-monitoring
#14
Subramania Iyer, Mohit Sharma, P Kishore, Jimmy Mathew, R Janarthanan, Raghuveer Reddy, Abhijeet Wakure, Sundeep Vijayaraghavan, S M Chetan Mali, Visakh Varma, Ashish Chaudhari, Swapnil Dhake, Akshay Omkumar, George Kurian, Rajesh Nair, Anil Mathew, Zachariah Paul, Malini Eapen, Lalitha Biswas
Introduction: Being able to counter immune-mediated rejection has for decades been the single largest obstacle for the progress of vascular composite allotransplantation (VCA). The human immune system performs the key role of differentiating the 'self ' from the 'non-self '. This, although is quintessential to eliminate or resist infections, also resists the acceptance of an allograft which it promptly recognises as 'non-self'. Materials and Methods: Pre-operative evaluation of the recipient evaluation included immunological assessment in the form of panel reactive antibodies (PRA), human leucocyte antigen (HLA) typing, donor-specific antibody detection assays (DSA) and complement-dependent cytotoxicity assays (CDC)...
May 2017: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
https://www.readbyqxmd.com/read/29343889/first-two-bilateral-hand-transplantations-in-india-part-1-from-vision-to-reality
#15
Subramania Iyer, Mohit Sharma, P Kishore, Jimmy Mathew, Sundeep Vijayaraghavan, Janarthanan Ramu, Abhijeet Wakure, Raghuveer Reddy, S M Mali Chetan, Visakh Varma, Ashish Chaudhari, Swapnil Dhake, Akshay Omkumar, V G Prasad
Introduction: Vascularized composite tissue allotransplantation is a relatively new concept, which was unavailable in the Indian subcontinent till a bilateral hand transplant was carried out successfully in January 2015. Materials and Methods: The setting up of the transplant programme involved obtaining legal clearances, creating public awareness, harnessing the institutional facilities, drawing up protocols, assembling the surgical team, managing immunological issues, rehabilitation and preparing the ancillary services...
May 2017: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
https://www.readbyqxmd.com/read/29319572/vascularized-composite-allotransplantation-of-the-elbow-joint-a-cadaveric-study
#16
Mitchell A Pet, Angelo B Lipira, Yusha Liu, Dennis Kao, Jason H Ko
BACKGROUND: Surgical options for the unreconstructable elbow are limited to arthrodesis, total arthroplasty, or osteoarticular allograft reconstruction. Each of these options is limited by severe functional impairment and/or high complication rates. Vascularized allotransplantation of the elbow joint has the potential to mitigate these complications. In this study, we describe our technique for harvesting the elbow for vascularized joint transplantation and demonstrate the flap's vascularity using contrast angiography...
April 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29305755/creation-of-dystrophin-expressing-chimeric-cells-of-myoblast-origin-as-a-novel-stem-cell-based-therapy-for-duchenne-muscular-dystrophy
#17
M Siemionow, J Cwykiel, A Heydemann, J Garcia-Martinez, K Siemionow, E Szilagyi
Over the past decade different stem cell (SC) based approaches were tested to treat Duchenne Muscular Dystrophy (DMD), a lethal X-linked disorder caused by mutations in dystrophin gene. Despite research efforts, there is no curative therapy for DMD. Allogeneic SC therapies aim to restore dystrophin in the affected muscles; however, they are challenged by rejection and limited engraftment. Thus, there is a need to develop new more efficacious SC therapies. Chimeric Cells (CC), created via ex vivo fusion of donor and recipient cells, represent a promising therapeutic option for tissue regeneration and Vascularized Composite Allotransplantation (VCA) due to tolerogenic properties that eliminate the need for lifelong immunosuppression...
April 2018: Stem Cell Reviews
https://www.readbyqxmd.com/read/29298238/desensitization-and-prevention-of-antibody-mediated-rejection-in-vascularized-composite-allotransplantation-by-syngeneic-hematopoietic-stem-cell-transplantation
#18
Howard D Wang, Samuel A J Fidder, Devin T Miller, Georg J Furtmüller, Ali R Ahmadi, Felix Nägele, Joseph Lopez, Amy Quan, Joshua Budihardjo, Denver M Lough, Burcu Akpinarli, Joanna W Etra, Dalibor Vasilic, Giorgio Raimondi, W P Andrew Lee, Robert A Montgomery, Zhaoli Sun, Gerald Brandacher
BACKGROUND: Candidates for vascularized composite allotransplantation (VCA) are frequently sensitized, putting them at risk for antibody-mediated rejection. Current desensitization strategies are imperfect and require a living-donor setting. Here we investigated the impact of sensitization on and the efficacy of a desensitization protocol utilizing syngeneic hematopoietic stem cell transplantation (HSCT) to prevent antibody-mediated rejection in VCA. METHODS: Skin transplants from Dark Agouti to Lewis rats were performed for sensitization...
April 2018: Transplantation
https://www.readbyqxmd.com/read/29280882/the-best-of-abdominal-wall-reconstruction
#19
REVIEW
Nakul Gamanlal Patel, Imran Ratanshi, Edward W Buchel
LEARNING OBJECTIVES: After reviewing this article, the participant should be able to: 1. List major risk factors for hernia formation and for failure of primary repair. 2. Outline an algorithmic approach to anterior abdominal wall reconstruction based on the degree of contamination, components involved in the deficit, and width of the hernia defect. 3. Describe appropriate indications for synthetic and biological mesh products. 4. List common flaps used in anterior abdominal wall reconstruction, including functional restoration strategies...
January 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29229149/transfusion-of-ethylene-carbodiimide-fixed-donor-splenocytes-prolongs-survival-of-vascularized-skin-allografts
#20
Jianke Ding, Shiqiang Liu, Dongliang Zhang, Yajuan Song, Xianjie Ma, Chenggang Yi, Baoqiang Song, Bo Xiao, Yingjun Su, Shuzhong Guo
BACKGROUND: Allograft rejection is a major obstacle to the widespread clinical application of vascularized composite allotransplantation. Recent studies revealed a noncytoreductive strategy to protect allografts by the transfusion of ethylene carbodiimide-fixed donor splenocytes (ECDI-SPs). To determine whether this approach offers advantages in protecting skin allografts, we examined the immunological protection of infusing ECDI-SPs with a 30-d administration of rapamycin on the skin allografts of mice...
January 2018: Journal of Surgical Research
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