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Vascularized composite allotransplantation

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https://www.readbyqxmd.com/read/28525412/new-avenues-of-vascularized-composite-allotransplantation-and-their-potential-risks-and-benefits
#1
Sotirios Tasigiorgos, Nicco Krezdorn, Ericka Bueno, Bohdan Pomahac
No abstract text is available yet for this article.
May 18, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28452881/differential-inflammatory-networks-distinguish-responses-to-bone-marrow-derived-vs-adipose-derived-mesenchymal-stem-cell-therapies-in-vascularized-composite-allotransplantation
#2
Ruben Zamora, Sudheer K Ravuri, Jan A Plock, Yoram Vodovotz, Vijay S Gorantla
BACKGROUND: Vascularized composite allotransplantation (VCA) is aimed at enabling injured individuals to return to their previous lifestyles. Unfortunately, VCA induces an immune/inflammatory response, which mandates lifelong, systemic immunosuppression, with attendant detrimental effects. Mesenchymal stem cells (MSC) - both adipose-derived (AD-MSC) and bone marrow-derived (BM-MSC) - can reprogram inflammation and have been suggested as an alternative to immunosuppression, but their mechanism of action is as yet not fully elucidated...
April 27, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28422434/rat-hindlimb-cryopreservation-and-transplantation-a-step-towards-organ-banking
#3
Amir Arav, Or Friedman, Yehudit Natan, Eyal Gur, Nir Shani
In 2016 over 5 million reconstructive procedures were performed in the USA. The recent successes of clinical vascularized composite allotransplantations (VCA), hand and face transplantations included, established the tremendous potential of these life-enhancing reconstructions. Nevertheless, Due to limited availability and lifelong immunosuppression, application is limited. Long term banking of composite transplants may increase the availability of esthetically compatible parts with partial or complete HLA matching, reducing the risk of rejection and the immunosuppressive burden...
April 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28371289/prolonged-cold-ischemia-time-results-in-local-and-remote-organ-dysfunction-in-a-murine-model-of-vascularized-composite-transplantation
#4
Néha Datta, Sean G Devaney, Ronald W Busuttil, Kodi Azari, Jerzy W Kupiec-Weglinski
Vascularized composite allotransplantation (VCA) is a viable reconstructive option for complex tissue defects. Although grafts with large muscular component may be uniquely susceptible to ischemia/reperfusion (I/R) syndrome, the safe cold ischemia time in VCA has not been established. We investigated the effects of cold ischemia on innate immune response and recipient survival in a murine orthotopic hindlimb transplantation model. Surprisingly, mice receiving grafts exposed to 6h or longer of cold storage demonstrated reduced survival and massive elevations in serum creatinine, BUN and creatine kinase, as compared to 1h of cold storage recipients...
March 30, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28371193/chronic-allograft-deterioration-a-clinical-reality-in-vascularized-composite-allotransplantation
#5
EDITORIAL
N Krezdorn, B Pomahac
No abstract text is available yet for this article.
March 30, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28361279/outcomes-after-hand-and-upper-extremity-transplantation
#6
Jaimie T Shores, Veronika Malek, W P Andrew Lee, Gerald Brandacher
Hand and upper extremity transplantation (HUET) has emerged as the most frequently performed reconstructive procedure in the burgeoning field of vascularized composite allotransplantation (VCA). VCA refers to a form of transplant with multiple tissue types that represents a viable treatment option for devastating injuries where conventional reconstruction would be unable to restore form and function. As hand transplantation becomes increasingly more common, discussions on advantages and disadvantages of the procedure seem to intensify...
May 2017: Journal of Materials Science. Materials in Medicine
https://www.readbyqxmd.com/read/28340673/the-advent-of-vascularized-composite-allotransplantation
#7
REVIEW
Curtis L Cetrulo, Zhi Yang Ng, Jonathan M Winograd, Kyle R Eberlin
Modern microsurgical techniques have made possible a broad spectrum of novel means for the reconstruction of complex bone and soft tissue defects. These techniques, in combination with developments in transplant immunology, have led to successful hand and facial allotransplantation and achievement of the highest rung in the reconstructive ladder - truly replacing like with like. The utilization of contemporary microsurgical technique in the context of vascularized composite allotransplantation (VCA) (1) permits successful technical execution and feasibility of VCA, (2) facilitates the study of immunologic tolerance in VCA preclinical models, and (3) optimizes functional VCA outcomes...
April 2017: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/28328655/vascularized-composite-allotransplantation-an-emerging-concept-for-burn-reconstruction
#8
Zhi Yang Ng, Alexandre G Lellouch, Tessa Drijkoningen, Irene A Chang, David H Sachs, Curtis L Cetrulo
Vascularized composite allotransplantation (VCA) has demonstrated utility in the reconstruction of extensive soft-tissue defects following severe burns. However, pre-VCA events such as multiple transfusions, previous transplantation and pregnancies, the use of skin allografts, and mechanical support devices may result in sensitization and ultimately exclude a burn patient, who may benefit most through VCA, from a hand or face transplant. The authors sought to identify the immunologic challenges involved. All reported VCA cases up to July 2016 were reviewed...
March 15, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28303433/the-decade-of-face-transplant-outcomes
#9
Maria Siemionow
At the 10th year anniversary of the first face transplantation, 37 patients worldwide, were the recipients of faces coming from human donors. Five patients died due to complications, noncompliance with immunosuppressive medications and development of cancer. Despite the initial debates and ethical concerns, face transplantation became a clinical reality with satisfactory functional outcomes. The areas of controversy still include the impact of life-long immunosuppression on otherwise healthy patients as well as the selection process of face transplant candidates...
May 2017: Journal of Materials Science. Materials in Medicine
https://www.readbyqxmd.com/read/28249789/hand-transplantation-evolution-of-a%C3%A2-personal-outlook
#10
REVIEW
W P Andrew Lee
The field of vascularized composite allotransplantation-combining advances in reconstructive surgery, transplantation, and immunology-offers great promise for patients with heretofore unsolvable problems. In the last 30 years, hand transplantation has progressed through the phases of being a research subject, a controversial clinical procedure, a more widely accepted and expanding field, and now a promising endeavor undergoing refined indications. Although many lessons have been learned, few procedures in the author's experience have been as life-transformative in restoring the body image, motor and sensory functions, activities of daily living, and personal autonomy as successful hand transplantation...
February 26, 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28211139/scabies-in-a-bilateral-hand-allograft-recipient-an-additional-mimicker-of-acute-skin-rejection-in-vascularized-composite-allotransplantation
#11
Jean Kanitakis, Emmanuel Morelon
Vascularized composite tissue allografts include skin, which frequently undergoes, in the early post-graft period, acute rejections. The diagnosis of acute rejection may be difficult as it can be mimicked by several dermatoses. We present a bilateral hand allograft recipient who developed, 16.5 years post-graft, cutaneous lesions raising suspicion about rejection. Physical examination and skin biopsy were diagnostic of scabies. This ectoparasitosis should be added in the list of dermatoses that can mimic allograft rejection in vascular composite allografts...
February 17, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28149214/robust-axonal-regeneration-in-a-mouse-vascularized-composite-allotransplant-model-undergoing-delayed-tissue-rejection
#12
Ying Yan, Matthew D Wood, Amy M Moore, Alison K Snyder-Warwick, Daniel A Hunter, Piyaraj Newton, Louis Poppler, Thomas H Tung, Philip J Johnson, Susan E Mackinnon
Background: Nerve regeneration in vascularized composite allotransplantation (VCA) is not well understood. Allogeneic transplant models experience complete loss of nerve tissue and axonal regeneration without immunosuppressive therapy. The purpose of this study was to determine the impact of incomplete immunosuppression on nerve regeneration. Methods: In this study, transgenic mice (4 groups in total) with endogenous fluorescent protein expression in axons (Thy1-YFP) and Schwann cells (S100-GFP) were used to evaluate axonal regeneration and Schwann cell (SC) migration in orthotopic-limb VCA models with incomplete immunosuppression using Tacrolimus (FK506)...
December 2016: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28121868/single-implantable-fk506-disk-prevents-rejection-in-vascularized-composite-allotransplantation
#13
Jignesh V Unadkat, Jonas T Schnider, Firuz G Feturi, Wakako Tsuji, Jacqueline M Bliley, Raman Venkataramanan, Mario G Solari, Kacey G Marra, Vijay S Gorantla, Alexander M Spiess
BACKGROUND: In vascularized composite allotransplantation, medication nonadherence leads to increased acute rejections. Improving medication adherence would improve overall allograft survival. Regionally delivered immunosuppression, targeted to sites of allorecognition, may reduce or eliminate the need for daily systemic immunosuppression. METHODS: The authors developed biodegradable FK disks containing FK506-loaded double-walled microspheres and tested their efficacy at preventing rejection in a Brown-Norway-to-Lewis rat hindlimb transplantation model...
February 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28118227/a-mouse-model-of-vascularized-skin-transplantation
#14
Jianke Ding, Yingjun Su, Shiqiang Liu, Yang Yang, Bo Zhou, Zhou Yu, Bo Xiao, Shuzhong Guo
BACKGROUND: Allogeneic skin tissues are highly antigenic and induce intensive immune rejection after composite tissue allotransplantation. Mouse models have advantages in mechanistic studies of immune rejection. However, due to technical challenge in vascular anastomosis with suture technique, mouse vascularized skin allotransplantation models are not widely used in studies of immune rejection. Therefore, the authors propose vascular anastomosis through cuff technique during allotransplantation of mouse donor free groin skin flaps to either recipient inguinal or cervical site...
May 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28079700/the-chimera-flap-a-quarter-century-odyssey
#15
Geoffrey G Hallock
Incredibly complicated multidimensional defects have always strained the ingenuity of the reconstructive surgeon. Secondary perhaps to vascularized composite allotransplantation as a solution to this dilemma, the compound flap has been developed to be a more useful and available alternative. Their greatest versatility has been proven by its subtype, the chimera flap. The chimera flap itself consists of multiple flaps, the latter possibly composed of bone, skin, muscle, and so on, where each part has an independent vascular supply, and each part is independent of any physical interconnection whatsoever with the other components, except where joined ultimately only to a common vascular pedicle...
February 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28058213/face-transplantation-anesthetic-challenges
#16
REVIEW
Aparna Dalal
Face transplantation is a complex vascular composite allotransplantation (VCA) surgery. It involves multiple types of tissue, such as bone, muscles, blood vessels, nerves to be transferred from the donor to the recipient as one unit. VCAs were added to the definition of organs covered by the Organ Procurement and Transplantation Network Final Rule and National Organ Transplant Act. Prior to harvest of the face from the donor, a tracheostomy is usually performed. The osteotomies and dissection of the midface bony skeleton may involve severe hemorrhagic blood loss often requiring transfusion of blood products...
December 24, 2016: World Journal of Transplantation
https://www.readbyqxmd.com/read/28029476/a-murine-model-of-orthotopic-periorbital-subunit-transplantation
#17
Bowen Gao, Bin Li, Xinxin Li, Jinhong Bae, Kaiyan Xiao, 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. We developed an orthotopic periorbital transplantation model in rats to facilitate further experimentation in this field. METHODS: In anatomical studies, the vascular distribution to and innervation of the periorbital unit were identified and recorded...
March 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28024304/nasal-unit-transplantation-a-cadaveric-anatomical-feasibility-study
#18
Amir H Dorafshar, Gerhard S Mundinger, Brent Robinson, Sami Tuffaha, Gerald Brandacher, Patrick Byrne, Robert L Walton
Background The science and technical acumen in the field of vascularized composite allotransplantation has progressed rapidly over the past 15 years, and transplantation of specialized units of the face, such as the nose, appears possible. No study to date has evaluated the technical feasibility of isolated nasal unit transplantation (NUT). In this study, we explore the anatomy and technical specifics of NUT. Methods In this study, four fresh cadaver heads were studied. Bilateral vascular pedicle dissections were performed in each cadaver...
May 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27997448/the-retroauricular-approach-to-the-facial-nerve-trunk
#19
Jordan W Swanson, Jason W Yu, Jesse A Taylor, Stephen Kovach, Suhail Kanchwala, Laurent Lantieri
BACKGROUND: Exposure of the common trunk of the facial nerve has traditionally been approached based on principles of parotidectomy, which is associated with high rates of facial nerve palsy and landmarks that may be unreliable. On the basis of experience gained with vascularized composite allotransplantation of the face, the authors propose a retroauricular approach that may be more time-effective and safe. METHODS: In the proposed retroauricular facial nerve approach, an incision is made posterior to the ear in the retroauricular sulcus, and dissection proceeds anteriorly to the mastoid fascia to the base of the conchal bowl...
March 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27984520/vascularized-composite-allotransplantation-at-a-crossroad-adopting-lessons-from-technology-innovation-to-novel-clinical-applications
#20
Wendy K Dean, Simon G Talbot
No abstract text is available yet for this article.
March 2017: Transplantation
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