Read by QxMD icon Read

Vascularized composite allotransplantation

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
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
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
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
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
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
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
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
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
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...
January 9, 2018: Annals of Plastic Surgery
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...
January 5, 2018: Stem Cell Reviews
Howard D Wang, Samuel A J Fidder, Devin T Miller, Georg J Furtmüller, Ali Reza Ahmadi, Felix Nägele, Joseph Lopez, Amy Quan, Joshua Budihardjo, Denver M Lough, Burcu Akpinarli, Joanna 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 (AMR). 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 AMR in VCA. METHODS: Skin transplants from Dark Agouti (DA) to Lewis rats were performed for sensitization...
January 2, 2018: Transplantation
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
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
Joanna W Etra, Giorgio Raimondi, Gerald Brandacher
PURPOSE OF REVIEW: For patients with devastating injuries in whom standard reconstruction is not an option, vascularized composite allotransplantation (VCA) has become a viable means of restoring form and function. However, immunological rejection continues to be a problem in VCA and has not yet been fully characterized. As the field is relatively new, much of the data on rejection and immunosuppression have been extrapolated from that of solid organ transplantation. In this review, we cover the basic mechanisms of rejection as they relate specifically to VCA with analysis of recent literature and future directions...
February 2018: Current Opinion in Organ Transplantation
Jérôme Duisit, Louis Maistriaux, Alexander Gerdom, Martial Vergauwen, Pierre Gianello, Catherine Behets, Benoît Lengelé
BACKGROUND: In the field of Vascularized Composite tissue Allotransplantation (VCA), the surgical design of facial subunit grafts is an evolving concept. The purpose of the present paper is to study the possibilities to divide the historical nose and lips face transplant into several morphological and functional subunit grafts, depending on their respective supply. METHODS: Our study was conducted in 20 adult cadavers. The facial artery and its branches were dissected bilaterally in 16 fresh and 4 embalmed heads...
November 11, 2017: Plastic and Reconstructive Surgery
Kavit R Amin, Jason K F Wong, James E Fildes
An important and often underinvestigated contributor to solid organ transplant rejection is ischemia reperfusion injury. This pathophysiological response releases damaging reactive oxygen species and cell stress signals that initiate inflammation, which has a critical role in priming the immune system for allorecognition. In time, this renders graft dysfunction and how this response is mediated in composite tissues remains unknown. Current protocols are drawn from solid organ transplantation with little scientific basis as to how this informs current hand transplantation practices...
December 2017: Journal of Hand Surgery
Radu Olariu, Julie Denoyelle, Franck M Leclère, Dzhuliya V Dzhonova, Thusitha Gajanayake, Yara Banz, Michael Hayoz, Mihai Constantinescu, Robert Rieben, Esther Vögelin, Adriano Taddeo
BACKGROUND: Immunosuppressive therapies derived from solid organ transplantation are effective in promoting survival of vascularized composite allotransplantation (VCA), but they cause serious side effects that are difficult to justify for this non-life-saving procedure. Unlike solid organ transplantation, hand and face transplants offer the possibility of site-specific immunosuppression for reducing systemic exposure while increasing intra-graft concentrations of the drug. Therefore, in this study, we tested whether a single intra-graft injection tacrolimus could promote VCA survival...
October 2017: Journal of Surgical Research
Jiaomiao Pei, Yang Li, Chen Chen, Xi Zhang, Shiping Wang, Yajuan Song, Bei Liu, Yingjun Su, Shuzhong Guo
Vascularized composite allotransplantation (VCA) is an emerging treatment for significant tissue defects. However, VCAs usually consist of multiple highly antigenic skin tissues. Previous studies have shown that the lymphatic system in skin plays important roles in the initiation of immune responses during acute rejection, by transporting T cells and antigen-presenting dendritic cells to regional lymph nodes. Therefore, we designed a new surgical treatment to inhibit lymphatic drainage of skin allografts and investigated whether this approach could promote the survival of allografts and suppress immunological events after transplantation...
September 19, 2017: Annals of Plastic Surgery
Yur-Ren Kuo, Chien-Chang Chen, Yen-Chou Chen, Ching-Ming Chien
Donor mesenchymal stem cells (MSCs) could prolong vascularized composite allotransplantation (VCA) survival in our previous studies. However, recipient adipose tissue is easier to harvest than donor tissue for preconditioning modulation. Hence, this study investigated the efficacy of recipient autologous adipose-derived stem cells (rADSCs) for VCA survival. The heterotopic hind-limb transplantation from female donor to male recipient was performed in outbred miniature swine. Group I ( n = 6) was untreated controls...
August 2017: Cell Transplantation
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"