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Vascularized composite allotransplantation

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
Martin J Hoogduijn
No abstract text is available yet for this article.
October 12, 2016: Transplantation
M Clerc, J Prothet, T Rimmelé
Composite tissue allotransplantation (CTA) is a complex procedure requiring a multidisciplinary collaboration between surgeons, anesthetists, and transplantation specialists. We will describe the perioperative management of a bilateral forearm allograft performed at our facility. A 40-year-old man who lost both forearms was registered on the transplant waiting list; a suitable graft was available 11months later. Anesthesia required planning for vascular access, hemodynamic monitoring, fluid therapy management and prevention of deep vein thrombosis...
June 2016: Hand Surgery and Rehabilitation
Arash Momeni, Benjamin Chang, L Scott Levin
The reconstructive principle of replacing "like with like" is best met with vascularized composite allotransplantation in which the components of an existing defect are "matched" to the greatest extent possible in a single stage restoration. Hand transplantation is a labor-intensive and time-intensive process and can be conceptualized into distinct phases that include (1) patient selection and preoperative preparation, (2) technical execution of the procedure, and (3) postoperative rehabilitation and follow-up...
November 2016: Journal of Materials Science. Materials in Medicine
C Anton Fries, Carole Y Villamaria, Jerry R Spencer, Rory F Rickard, Vijay S Gorantla, Michael R Davis
BACKGROUND: The restoration of complex tissue deficits with vascularized composite allotransplantation is a paradigm shift in reconstructive surgery. Clinical adoption of vascularized composite allotransplantation is limited by the need for systemic immunosuppression, with associated morbidity and mortality. Small-animal models lack the biological fidelity and preclinical relevance to enable translation of immunologic insights to humans. Large-animal models have been described; however, limitations persist, including the inability of heterotopic models to evaluate functional nerve regeneration, and the sensitivity of primates to toxicity of immunosuppressive drugs...
September 2016: Plastic and Reconstructive Surgery
Jorge Bonastre, Luis Landín, Pedro Bolado, César Casado-Sánchez, Eduardo López-Collazo, Jesús Díez
BACKGROUND: Previous studies on solid organ transplantation have shown that cold ischemia contributes to the development of chronic allograft vasculopathy. The authors evaluated the effect of cold ischemia on the development of chronic rejection in vascularized composite allotransplantation. METHODS: Thirty rat hindlimbs were transplanted and divided into two experimental groups: immediate transplantation and transplantation after 7 hours of cold ischemia. The animals received daily low-dose immunosuppression with cyclosporine A for 2 months...
September 2016: Plastic and Reconstructive Surgery
Antoine Sicard, Jean Kanitakis, Valérie Dubois, Palmina Petruzzo, Lionel Badet, Olivier Thaunat, Emmanuel Morelon
PURPOSE OF REVIEW: Vascularized composite allotransplantation (VCA) has several immunological peculiarities that imply a specific immune monitoring. Here, we provide an integrated view of current procedures of immune monitoring in VCA and potential complementary approaches learned from organ transplantation. RECENT FINDINGS: Because the skin is highly immunogenic and is the main target of the alloimmune response, immune monitoring in VCA essentially relies on visual inspection and pathological examination of for-causes and protocol skin biopsies...
October 2016: Current Opinion in Organ Transplantation
Annemarie Weissenbacher, Alexandre Loupy, Anil Chandraker, Stefan Schneeberger
PURPOSE OF REVIEW: The presence of donor-specific antibodies (DSA) increases the risk of graft failure. Although DSA characteristics, human leukocyte antigen class specificity, mean fluorescence intensity and immunoglobulin G subclasses, and their impact on the graft are quite well studied in solid organ transplants, very little information is known about their impact on vascularized composite allotransplantation (VCA). The aim of this review is to highlight recent publications regarding occurrence and effects of DSA, their follow-up and treatment in the field of VCA...
October 2016: Current Opinion in Organ Transplantation
Sheila Jowsey-Gregoire, Martin Kumnig
PURPOSE OF REVIEW: Vascularized composite allotransplantation (VCA) encompasses hand, face, uterus, penile and lower extremity transplantation. Psychosocial factors are recognized as important, but no standard approach to the evaluation, selection or posttransplant care has been described and thus, the development of a standardized approach is needed. RECENT FINDINGS: Various psychosocial assessment tools have been reported. Body image and the functional impact of hand versus face transplantation are notable issues...
October 2016: Current Opinion in Organ Transplantation
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
B Kern, J D Budihardjo, S Mermulla, A Quan, C Cadmi, J Lopez, M Khusheim, S Xiang, J Park, G J Furtmüller, K A Sarhane, S Schneeberger, W P A Lee, A Hoke, S Tuffaha, G Brandacher
Improved nerve regeneration and functional outcomes would greatly enhance the utility of vascularized composite allotransplantation (VCA) such as hand and upper extremity transplantation. However, research aimed at achieving this goal has been limited by the lack of a functional VCA animal model. We have developed a novel rat mid-humeral forelimb transplant model that allows for the characterization of upper extremity functional recovery following transplantation. At the final end-point of 12 weeks, we found that animals with forelimb transplantation including median, ulnar, and radial nerve coaptation demonstrated significantly improved grip strength (1...
August 8, 2016: American Journal of Transplantation
Dimitra Kotsougiani, Caroline A Hundepool, Liselotte F Bulstra, Patricia Friedrich, Alexander Y Shin, Allen T Bishop
Current vascularized composite allotransplantation (VCA) transplantation protocols rely upon life-long immune modulation to maintain tissue perfusion. Alternatively, bone-only VCA viability may be maintained in small animal models using surgical angiogenesis from implanted autogenous vessels to develop a neoangiogenic bone circulation that will not be rejected. This study tests the method's efficacy in a large animal model as a bridge to clinical practice, quantifying the remodeling and mechanical properties of porcine tibial VCAs...
July 29, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Arthur L Caplan, Laura L Kimberly, Brendan Parent, Michael Sosin, Eduardo D Rodriguez
BACKGROUND: For men with significant genitourinary injury, penile transplantation is being considered as an option when reconstruction is not feasible or proves unacceptable to the injured patient. METHODS: A review of the literature was conducted to assess the current state of penile reconstruction and transplantation options, as well as to evaluate scholarly research addressing the ethical dimensions of penile transplantation. RESULTS: The state of penile transplantation is elementary...
July 7, 2016: Transplantation
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
Sarah-Jayne Edmondson, Fadi Issa
No abstract text is available yet for this article.
July 2016: Transplantation
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
Nataliya V Kostereva, Yong Wang, Derek R Fletcher, Jignesh V Unadkat, Jonas T Schnider, Chiaki Komatsu, Yang Yang, Donna B Stolz, Michael R Davis, Jan A Plock, Vijay S Gorantla
Impaired nerve regeneration and inadequate recovery of motor and sensory function following peripheral nerve repair remain the most significant hurdles to optimal functional and quality of life outcomes in vascularized tissue allotransplantation (VCA). Neurotherapeutics such as Insulin-like Growth Factor-1 (IGF-1) and chondroitinase ABC (CH) have shown promise in augmenting or accelerating nerve regeneration in experimental models and may have potential in VCA. The aim of this study was to evaluate the efficacy of low dose IGF-1, CH or their combination (IGF-1+CH) on nerve regeneration following VCA...
2016: PloS One
Jihoon Park, Sangjun Yim, Seok-Chan Eun
Face allotransplantation represents a novel frontier in complex human facial defect reconstruction. To develop more refined surgical techniques and yield fine results, it is first imperative to make a suitable animal model. The development of a composite facial allograft model in swine is more appealing: the facial anatomy, including facial nerve and vascular anatomy, is similar to that of humans. Two operative teams performed simultaneously, one assigned to harvest the donor and the other to prepare the recipient in efforts to shorten operative time...
June 2016: Journal of Craniofacial Surgery
Brian Gastman, Ahmed M Hashem, Risal Djohan, Steven Bernard, Mark Hendrickson, Graham Schwarz, Bahar B Gharb, Antonio Rampazzo, Anthony Fernandez, James Zins, Gary S Hoffman, Gaby Doumit, Maria Siemionow, Francis Papay
BACKGROUND: Granulomatosis with polyangiitis (Wegener granulomatosis) is a rare disease that commonly starts in the craniofacial region and can lead to considerable facial disfigurement. Granulomas and vasculitis, however, can involve many other tissues (especially pulmonary and renal). Dermatologic and subcutaneous components can lead to malignant pyoderma. METHODS: The authors describe a unique pathologic condition, where significant Le Fort type trauma was associated with subsequent development of granulomatosis with polyangiitis and malignant pyoderma...
June 2016: Plastic and Reconstructive Surgery
Jesse C Selber, Edward I Chang, Mark W Clemens, Lilian Gaber, Matthew M Hanasono, Michael Klebuc, Roman J Skoracki, Todd Trask, Peirong Yu, A Osama Gaber
BACKGROUND: Vascularized composite allotransplantation is an emerging field, but the complications of lifelong immunosuppression limit indications. Vascularized composite allotransplantation in solid organ recipients represents a unique opportunity because immunosuppression has already been accepted. This report of a simultaneous scalp, skull, kidney, and pancreas transplant represents both the first skull-scalp transplant and combination of a vascularized composite allotransplantation with double organ transplantation...
June 2016: Plastic and Reconstructive Surgery
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