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Zan T, Wang W, Li H, Liu C, Zhu H, Xie Y, Zhou S, Gao Y, Huang X, Gu S, Liu K, Gu B, Xie F, Pu LLQ, Li Q. Autologous Tissue Repair and Total Face Restoration. JAMA Otolaryngol Head Neck Surg 2024; 150:695-703. [PMID: 38958964 PMCID: PMC11310821 DOI: 10.1001/jamaoto.2024.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/02/2024] [Indexed: 07/04/2024]
Abstract
Importance Total face restoration remains a challenge in modern reconstructive surgery. After 17 years of experiments and preliminary clinical studies, a new concept of face prefabrication was developed for face restoration with autologous tissue. Objective To evaluate the long-term results of face restoration with autologous tissue and report a finalized and standardized approach of face prefabrication. Design, Setting, and Participants In this single-center long-term retrospective study, 32 patients who underwent total face restoration between 2005 and 2022 were reviewed. These patients underwent total facial reconstruction, which included flap prefabrication, 3-dimensional printing, tissue expansion, and flap transfer with aid of indocyanine green angiography (IGA). The flap first undergoes prefabrication by transferring vascularized fascia under the skin of the selected chest. A tissue expander is then placed under the fascia to create a large, thin, reliable skin flap after expansion. Once completed, the flap is transferred to the face during the second stage of the reconstruction. Intraoperative IGA is performed to guide the design of subsequent openings for facial fissures. Data were analyzed from July to September 2023. Main Outcomes and Measures Flap healing, reconstructive outcome, and patient recovery were assessed during follow-up. Three questionnaires, including the 36-Item Short Form Health Survey (SF-36), Aesthetic and Functional Status Score of Facial Soft-Tissue Deformities/Defects, and the EuroQoL Health-Related Quality of Life (EQ-5D-5L), were used to evaluate the quality of life and satisfaction with facial aesthetic and functional status. Results Of 24 included patients, 14 (58%) were male, and the mean (range) age was 32.9 (8-62) years. The mean (range) follow-up was 5.6 (2-12) years. All patients reported a significant improvement in quality of life (SF-36), especially in mean (SD) social functioning (preoperative score, 53.65 [34.51]; postoperative score, 80.73 [19.10]) and emotional stability (preoperative score, 56.67 [25.55]; postoperative score, 71.17 [18.51]). A total of 22 patients (92%) went back to work. Mean (SD) facial aesthetic status (preoperative score, 4.96 [3.26]; postoperative score, 11.52 [3.49]; P < .001) and functional status (preoperative score, 11.09 [3.51]; postoperative score, 15.78 [3.26]; P < .001) also improved. In addition, there was a significant increase in overall satisfaction and self-reported health status (preoperative score, 8.13 [1.52]; postoperative score, 3.58 [2.31]). Conclusions and Relevance In this study, 5-year follow-up results suggested that this innovative approach to total face restoration offered a safe and valid option for indicated patients, with acceptable reconstructive and cosmetic outcomes.
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Affiliation(s)
- Tao Zan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wenjin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Haizhou Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Caiyue Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hainan Zhu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yun Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Shuangbai Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yashan Gao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Shuchen Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Kai Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Bin Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Feng Xie
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lee L. Q. Pu
- Division of Plastic Surgery, University of California, Davis, Sacramento
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Kiefer J, Zeller J, Schneider L, Thomé J, McFadyen JD, Hoerbrand IA, Lang F, Deiss E, Bogner B, Schaefer AL, Chevalier N, Horner VK, Kreuzaler S, Kneser U, Kauke-Navarro M, Braig D, Woollard KJ, Pomahac B, Peter K, Eisenhardt SU. C-reactive protein orchestrates acute allograft rejection in vascularized composite allotransplantation via selective activation of monocyte subsets. J Adv Res 2024:S2090-1232(24)00291-1. [PMID: 38992424 DOI: 10.1016/j.jare.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/24/2024] [Accepted: 07/08/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Despite advancements in transplant immunology and vascularized composite allotransplantation (VCA), the longevity of allografts remains hindered by the challenge of allograft rejection. The acute-phase response, an immune-inflammatory reaction to ischemia/reperfusion that occurs directly after allogeneic transplantation, serves as a catalyst for graft rejection. This immune response is orchestrated by acute-phase reactants through intricate crosstalk with the mononuclear phagocyte system. OBJECTIVE C-reactive protein (CRP), a well-known marker of inflammation, possesses pro-inflammatory properties and exacerbates ischemia/reperfusion injury. Thus, we investigated how CRP impacts acute allograft rejection. METHODS Prompted by clinical observations in facial VCAs, we employed a complex hindlimb transplantation model in rats to investigate the direct impact of CRP on transplant rejection. RESULTS Our findings demonstrate that CRP expedites allograft rejection and diminishes allograft survival by selectively activating non-classical monocytes. Therapeutic stabilization of CRP abrogates this activating effect on monocytes, thereby attenuating acute allograft rejection. Intravital imagining of graft-infiltrating, recipient-derived monocytes during the early phase of acute rejection corroborated their differential regulation by CRP and their pivotal role in driving the initial stages of graft rejection. CONCLUSION The differential activation of recipient-derived monocytes by CRP exacerbates the innate immune response and accelerates clinical allograft rejection. Thus, therapeutic targeting of CRP represents a novel and promising strategy for preventing acute allograft rejection and potentially mitigating chronic allograft rejection.
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Affiliation(s)
- Jurij Kiefer
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Johannes Zeller
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Laura Schneider
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Julia Thomé
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - James D McFadyen
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Isabel A Hoerbrand
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Friederike Lang
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Emil Deiss
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Balázs Bogner
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Anna-Lena Schaefer
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Nina Chevalier
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Verena K Horner
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Sheena Kreuzaler
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - David Braig
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Kevin J Woollard
- Centre for Inflammatory Disease, Imperial College London, London, UK
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
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Panayi AC, Knoedler S, Kauke-Navarro M, Haug V, Obed D, Pomahac B. Face transplantation: a bibliometric analysis of the top 100 most cited articles. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Ozmen S, Findikcioglu K, Sibar S, Tuncer S, Ayhan S, Guz G, Unal Y, Aslan S. First Composite Woman-to-Woman Facial Transplantation in Turkey: Challenges and Lessons to Be Learned. Ann Plast Surg 2023; 90:87-95. [PMID: 36534107 DOI: 10.1097/sap.0000000000003323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT After the first face transplantation from woman to woman we performed in our clinic, it was aimed to eliminate the lack of knowledge about the subject in the literature by transferring our experiences and long-term results to the problems we had with the patient. A 20-year-old patient underwent partial osteomyocutaneous facial transplant (22nd facial transplant), which included 2 functional units of the face. The patient had no major problems in the early period and had a good aesthetic appearance. In the postoperative period, the patient ended her social isolation and adopted the transplanted face.In the late period, secondary surgical interventions, management of the problems caused by immunosuppression, and the patient's living in a remote location to our clinic were the difficulties encountered. Six revision surgeries were performed after the transplantation. Due to immunosuppression, opportunistic infections and metabolic problems required intermittent hospitalization. The patient died at the end of 56 months because of complications secondary to immunosuppression.A successful transplant involves the management of long-term problems rather than a successful tissue transfer in the early period. In today's conditions, long-term success can be achieved with a good patient compliance, as well as each team member should take an active role in the team at the transplantation centers. More case series are needed to adapt the standard treatment and follow-up protocols for solid organ transplantations for composite tissue allotransplantations. This will be possible by sharing the results and experiences transparently in the centers where face transplantation is performed worldwide.
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Affiliation(s)
- Selahattin Ozmen
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Koç University Hospital, Istanbul
| | | | - Serhat Sibar
- Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Serhan Tuncer
- Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Suhan Ayhan
- Departments of Plastic, Reconstructive and Aesthetic Surgery
| | | | | | - Selcuk Aslan
- Psychiatry, Gazi University Hospital, Ankara, Turkey
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Benedict J. Patient Advocacy in Vascularized Composite Allotransplantation. Front Psychol 2022; 13:943393. [PMID: 35923735 PMCID: PMC9340068 DOI: 10.3389/fpsyg.2022.943393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
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Parker A, Chaya BF, Rodriguez-Colon R, Hao Y, Kurian K, Trilles J, Boczar D, Brydges H, Rodriguez ED. Recipient Selection Criteria for Facial Transplantation: A Systematic Review. Ann Plast Surg 2022; 89:105-112. [PMID: 35749814 DOI: 10.1097/sap.0000000000003255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recipient selection is an important determinant of surgical outcomes in facial transplantation (FT). Appropriately, each FT program develops their own guidelines for recipient selection criteria. Currently, there is no resource to simultaneously assess and identify similarities and differences between these guidelines. Such information could be useful in distinguishing areas of FT that are well understood from those that could benefit from further exploration. METHODS We performed a systematic review of the scientific literature from inception to June 18, 2021, using Pubmed, Embase, Cochrane Library, and Scopus to identify articles pertaining to recipient selection criteria. Clinical trials were identified through the Clinicaltrials.gov registry. United States and international program websites were reviewed for patient-facing information. RESULTS Our systematic review yielded 90 suitable articles, 8 clinical trials, and 7 program websites containing the recipient selection criteria of 24 different FT programs. The most reported on recipient criteria were age, positive human immunodeficiency viral status (HIV+), positive hepatitis C viral status, psychosocial stability, and medical compliance. Other criteria were rarely addressed, such as blindness and recipient immune status. CONCLUSIONS Guidelines among different face transplant programs are changing over time. We found consensus on certain recipient selection criteria, but the majority remain program or surgeon dependent, emphasizing that FT is still an evolving procedure. Although most programs reported on their recipient selection criteria, the rationale was often missing. Further discussion about recipient selection criteria and the reasoning behind employing or changing them will help advance the field.
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Affiliation(s)
| | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
| | | | - Yvonne Hao
- From the New York University Grossman School of Medicine
| | - Keerthi Kurian
- California Northstate University, College of Medicine, Elk Grove, CA
| | - Jorge Trilles
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
| | - Daniel Boczar
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
| | - Hilliard Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
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7
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Facial Transplantation. Facial Plast Surg Clin North Am 2022; 30:255-269. [DOI: 10.1016/j.fsc.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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da Graca B, Johannesson L, Testa G, Wall AE. The Ethical Evolution of Uterus Transplantation From Concept to Clinical Procedure. Clin Obstet Gynecol 2022; 65:24-36. [PMID: 35045022 DOI: 10.1097/grf.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Uterus transplantation (UTx) offers women with absolute uterine factor infertility a path to motherhood that enables them to carry their own pregnancy. Debates about the ethics of UTx have evolved in tandem with its clinical evolution: clinical trials have provided evidence regarding risks and benefits to donors and recipients that were initially uncertain; technical advances have altered the balance between risks and benefits; and the experiences of donors and recipients has revealed questions that were not anticipated. As UTx transitions to a clinical procedure, questions remain about long-term risks and benefits, applications beyond carrying a pregnancy, and cost and access.
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Affiliation(s)
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center
- Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center
| | - Anji E Wall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center
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9
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Personality, Success, and Beyond: The Layperson's Perception of Patients With Facial Transplantation. J Craniofac Surg 2021; 33:385-389. [PMID: 34690306 DOI: 10.1097/scs.0000000000008297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While the goal of facial vascularized composite allotransplantation (FVCA) is to provide patients with improved physical and social function, no study has evaluated layperson perception of social acceptance and perceived career success of patients with FVCA. The purpose of this study was to determine how FVCA changes social acceptance and perceived career success of patients with facial disfiguration. METHODS Eight hundred fifteen laypersons were surveyed through Mechanical Turk to evaluate their perceptions of patients with FVCA. Respondents were shown facial photographs of patients pre-FVCA, post-FVCA, and matched controls and evaluated these photos on 26 items of perceived social acceptance and career success. Responses were analyzed using descriptive statistics and the Wilcoxon signed-rank test. RESULTS Both male and female post-FVCA photos were perceived as significantly more socially accepted and professionally successful than their pre-FVCA photos in at least 21 out of 26 items (P < 0.001 for all), but the posttransplant patients scored lower than their control in at least 25 out of 26 items (P < 0.001 for all). Additionally, there were discrepancies in findings based on patient gender. CONCLUSIONS This study suggests that while FVCA has a significantly positive impact on social acceptance and perceived professional success, it does not fully reinstate these qualities. Furthermore, varying surgical outcomes and/or cognitive biases (such as gender) may impact perceptions of the individual by the public. Our findings suggest a need to standardize practices to better predict and improve outcomes and encourage surgeons to consider patient factors such as gender when planning these procedures.
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10
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Visual Release Hallucinations After Facial Allotransplantation. Harv Rev Psychiatry 2021; 29:327-334. [PMID: 34033593 DOI: 10.1097/hrp.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Wang YC, Lee SS, Ramachandran S, Lin YN, Chen RF, Lin SD, Lai CS, Kuo YR. Attitudes toward face transplantation in Asia: A survey of Taiwanese population. Microsurgery 2021; 41:599-602. [PMID: 34019315 DOI: 10.1002/micr.30755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Yu-Chi Wang
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Su-Shin Lee
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Savitha Ramachandran
- Department of Plastic and Reconstructive Surgery, KK Women's and Children's Hospital, Singapore.,Academic Clinical Program for Musculoskeletal Sciences, Duke-NUS Graduate Medical School, Singapore.,Department of Plastic and Reconstructive Surgery, Singapore General Hospital, Singapore
| | - Yun-Nan Lin
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Rong-Fu Chen
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Sin-Daw Lin
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Sheng Lai
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yur-Ren Kuo
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Academic Clinical Program for Musculoskeletal Sciences, Duke-NUS Graduate Medical School, Singapore.,Department of Plastic and Reconstructive Surgery, Singapore General Hospital, Singapore.,Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Shokri T, Saadi R, Wang W, Reddy L, Ducic Y. Facial Transplantation: Complications, Outcomes, and Long-Term Management Strategies. Semin Plast Surg 2020; 34:245-253. [PMID: 33380909 DOI: 10.1055/s-0040-1721760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.
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Affiliation(s)
- Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Robert Saadi
- Department of Otolaryngology - Head & Neck Surgery, Penn State Health, Hershey, Pennsylvania
| | - Weitao Wang
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Likith Reddy
- Department of Oral and Maxillofacial Surgery, Texas A&M College of Dentistry, Dallas, Texas
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Kimberly LL, Ramly EP, Alfonso AR, Diep GK, Berman ZP, Rodriguez ED. Equity in access to facial transplantation. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106129. [PMID: 33060187 DOI: 10.1136/medethics-2020-106129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
We examine ethical considerations in access to facial transplantation (FT), with implications for promoting health equity. As a form of vascularised composite allotransplantation, FT is still considered innovative with a relatively low volume of procedures performed to date by a small number of active FT programmes worldwide. However, as numbers continue to increase and institutions look to establish new FT programmes, we anticipate that attention will shift from feasibility towards ensuring the benefits of FT are equitably available to those in need. This manuscript assesses barriers to care and their ethical implications across a number of considerations, with the intent of mapping various factors relating to health equity and fair access to FT. Evidence is drawn from an evolving clinical experience as well as published scholarship addressing several dimensions of access to FT. We also explore novel concerns that have yet to be mentioned in the literature.
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Affiliation(s)
- Laura L Kimberly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
- Division of Medical Ethics, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
| | - Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
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Rifkin WJ, Manjunath AK, Kantar RS, Jacoby A, Kimberly LL, Gelb BE, Diaz-Siso JR, Rodriguez ED. A Comparison of Immunosuppression Regimens in Hand, Face, and Kidney Transplantation. J Surg Res 2020; 258:17-22. [PMID: 32977237 DOI: 10.1016/j.jss.2020.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/12/2020] [Accepted: 08/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Authors have speculated that vascularized composite allotransplantation (VCA) recipients may require greater maintenance immunosuppression than solid organ transplant (SOT) recipients due to the higher antigenicity of skin. However, detailed comparisons of VCA and SOT immunosuppression regimens have been limited. METHODS Hand and face VCA recipient immunosuppression data were collected through a systematic literature review. Kidney recipient data were obtained through a retrospective chart review of the authors' institution. Prednisone and mycophenolate mofetil (MMF) doses were compared between VCA and kidney recipients at predefined follow-up intervals (<1, 1-5, and >5 y). Tacrolimus target trough levels (TTTL) were compared at follow-up intervals of 1-5 and >5 y, and stratified into our institution's kidney transplant risk-based target ranges (4-6 ng/mL, 6-8 ng/mL) or higher (>8 ng/mL). RESULTS Immunosuppression data were available for 57 VCA and 98 kidney recipients. There were no significant differences in prednisone doses between groups at all follow-up intervals. VCA recipient mean MMF dose was significantly greater at <1-y (1.71 ± 0.58 versus 1.16 ± 0.55 gm/d; P = 0.01). For VCA recipients, there was a significant difference (P = 0.02) in TTTL distribution over the three predefined therapeutic ranges (4-6 ng/mL, 6-8 ng/mL, and >8 ng/mL) between 1 and 5 y (24.0%, 20.0%, 56.0%, respectively) and >5 y (28.6%, 42.9%, 28.6%). CONCLUSIONS At longer follow-up, VCA and kidney recipients receive comparable MMF/prednisone doses, and most VCA recipients are treated with TTTL similar to kidney recipients. Further research may improve our understanding of VCA's complex risk/benefit ratio, and enhance informed consent.
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Affiliation(s)
- William J Rifkin
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Amit K Manjunath
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Adam Jacoby
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Laura L Kimberly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Bruce E Gelb
- Department of Surgery, NYU Langone Health, New York, New York
| | - J Rodrigo Diaz-Siso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York.
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Before and After: What Has Changed in the Attitude of Turkish Society Regarding Face Transplantations? Ann Plast Surg 2020; 82:692-699. [PMID: 31021843 DOI: 10.1097/sap.0000000000001877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Face transplantation is one of the most popular and controversial subjects of plastic surgery today. Although there are various surveys on the subject, there is no study comparing the past and the present social viewpoint and behavioral preferences for face transplantations across the world. In this study, we aimed to investigate the changes in the views of the Turkish society with respect to face transplantation from past to present. For this purpose, 1000 volunteer participants were questioned in terms of demographics and their perspective and preferences on organ and face transplantation. The results of the study were compared with the past data, and based on the results, the level of consciousness and awareness of the Turkish society about the subject has increased; the rate risk taking for immunosuppression has decreased, and instead, the rate of having an undecided stance has increased, and this attitude continues even if the risk is resolved. With these results, we can conclude that the greatest handicap for face transplantation in the Turkish society today is immunosuppression and the associated risks. We believe that new drug protocols and monitoring of patient outcomes for longer periods as well as more extensive clinical applications may be beneficial in addressing this issue.
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Smith WR, Sisti D. Ethics and ego dissolution: the case of psilocybin. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106070. [PMID: 32461241 PMCID: PMC9202314 DOI: 10.1136/medethics-2020-106070] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 05/20/2023]
Abstract
Despite the fact that psychedelics were proscribed from medical research half a century ago, recent, early-phase trials on psychedelics have suggested that they bring novel benefits to patients in the treatment of several mental and substance use disorders. When beneficial, the psychedelic experience is characterized by features unlike those of other psychiatric and medical treatments. These include senses of losing self-importance, ineffable knowledge, feelings of unity and connection with others and encountering 'deep' reality or God. In addition to symptom relief, psychedelic experiences often lead to significant changes in a patient's personality and worldview. Focusing on the case of psilocybin, we argue that the peculiar features of psychedelics pose certain novel risks, which warrant an enhanced informed consent process-one that is more comprehensive than what may be typical for other psychiatric medications. We highlight key issues that should be focused on during the consent process and suggest discussion prompts for enhanced consent in psychedelic psychiatry. Finally, we respond to potential objections before concluding with a discussion of ethical considerations that will arise as psychedelics proceed from highly controlled research environments into mainstream clinical psychiatry.
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Affiliation(s)
- William R Smith
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dominic Sisti
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Kimberly LL, McQuinn MW, Caplan AL, Levy-Carrick NC. The Ethics of Psychosocial Assessment in Vascularized Composite Allotransplantation: A Call for Transparency of Process to Support the Equitable Selection of Patients. THE JOURNAL OF CLINICAL ETHICS 2019. [DOI: 10.1086/jce2019304318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Ngaage LM, Ike S, Elegbede A, Vercler CJ, Gebran S, Liang F, Rada EM, Cooney C, Brandacher G, Redett RJ, Johannesson L, Rasko YM. The changing paradigm of ethics in uterus transplantation: a systematic review. Transpl Int 2019; 33:260-269. [PMID: 31674693 DOI: 10.1111/tri.13548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/03/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
The first uterus transplantation was performed in 2000. As key milestones are reached (long-lasting graft survival in 2011, and first birth from a transplanted womb in 2014), the ethical debate around uterus transplant evolves. We performed a systematic review of articles on uterus transplantation. Ethical themes were extracted and categorized according to four bioethical principles. Papers were divided into time periods separated by key events in uterus transplant history: Phase I (first technical achievement, 2002-2011), Phase II (clinical achievement, 2012-2014), and Phase III (after the first childbirth, 2015-2018). Eighty-one articles were included. The majority of ethics papers were published in Phase III (65%, P < 0.0001), that is after the first birth. Eighty percent of papers discussed nonmaleficence making it the most discussed principle. The first birth acted as a pivotal point: nonmaleficence was discussed by a lower proportion of articles (P = 0.0073), as was beneficence (P = 0.0309). However, discussion of justice increased to become the most discussed principle of the time period (P = 0.0085). The ethical debate surrounding uterus transplantation has evolved around landmark events that signify scientific progress. As safety and efficacy become evident, the focus of ethical debate shifts from clinical equipoise to socioeconomic challenges and equitable access to uterus transplantation.
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Affiliation(s)
- Ledibabari M Ngaage
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Samantha Ike
- London North West University Healthcare Trust, London, UK
| | - Adekunle Elegbede
- Department of Plastic & Reconstructive Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian J Vercler
- Plastic Surgery Section, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Selim Gebran
- Division of Plastic & Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Fan Liang
- Division of Plastic & Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Erin M Rada
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Carisa Cooney
- Department of Plastic & Reconstructive Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gerald Brandacher
- Department of Plastic & Reconstructive Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic & Reconstructive Surgery, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Yvonne M Rasko
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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The Ethics of Facial Allotransplantation: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2425. [PMID: 31772878 PMCID: PMC6846319 DOI: 10.1097/gox.0000000000002425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/02/2019] [Indexed: 01/12/2023]
Abstract
Supplemental Digital Content is available in the text. Currently, there are more than 40 cases of facial allotransplantation performed by 13 different groups in 10 countries. Although it has become a potential option to reconstruct and restore the function and appearance of severely facially disfigured individuals, the ethical concerns of facial allotransplantation remain unsolved. We conducted a systematic review to better understand the ethical concerns on facial allotransplantation and the changing trends of the ethical debate over time.
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Abstract
BACKGROUND Face transplantation can offer functional and aesthetic restoration to patients who have exhausted their reconstructive options, improving quality of life and psychosocial integration. Ethical issues in face transplantation abound, including questions of patient selection and evaluation before transplantation. To date, there has been no study of ethicists' opinions regarding face transplantation. METHODS An online survey of attendees of the 2015 International Conference on Clinical Ethics Consultation (n = 401) assessed ethicists' opinions about face transplantation. Questions examined the risk-to-benefit ratio of immunosuppression; permissibility of face transplantation in subpopulations (including children and blind patients); donor-recipient age, sex, and ethnicity mismatches; and ethical oversight. RESULTS Most ethicists (84 percent) agreed that it is permissible to perform a face transplantation on an adult in the absence of clear medical contraindications. Most respondents also agreed that it is permissible to perform a face transplantation on a child (62 percent) or a blind patient (61 percent), yet demonstrated less consensus regarding the permissibility of performing a face transplantation on patients with an increased risk of immune rejection. Respondents were generally supportive of age, sex, and ethnicity mismatches, with 43 percent indicating that it is permissible to have a sex mismatch. The majority answered that face transplantation should be covered by federal insurance (74 percent). CONCLUSIONS This study provides insight into clinical ethicists' views regarding face transplantation. Most ethicists support the ethical permissibility of face transplantation, and did not have concerns about age, sex, and ethnicity mismatches. These findings highlight emerging areas of consensus regarding the ethical permissibility of face transplantation.
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Analysis of factors involved in brain-death donor processing for face transplantation in Korea: How much time is available from brain death to transplantation? Arch Plast Surg 2019; 46:405-413. [PMID: 31462025 PMCID: PMC6759447 DOI: 10.5999/aps.2019.00150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background Face transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process. Methods A retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs. Results The patient base (n=1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (±15.3). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (±14 hours 50 minutes) and 22 hours 57 minutes (±16 hours 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%). Conclusions When face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.
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Abstract
OBJECTIVE We describe the first successful penis transplant in the United States in a patient with a history of subtotal penectomy for penile cancer. BACKGROUND Penis transplantation represents a new paradigm in restoring anatomic appearance, urine conduit, and sexual function after genitourinary tissue loss. To date, only 2 penis transplants have been performed worldwide. METHODS After institutional review board approval, extensive medical, surgical, and radiological evaluations of the patient were performed. His candidacy was reviewed by a multidisciplinary team of surgeons, physicians, psychiatrists, social workers, and nurse coordinators. After appropriate donor identification and recipient induction with antithymocyte globulin, allograft procurement and recipient preparation took place concurrently. Anastomoses of the urethra, corpora, cavernosal and dorsal arteries, dorsal vein, and dorsal nerves were performed, and also inclusion of a donor skin pedicle as the composite allograft. Maintenance immunosuppression consisted of mycophenolate mofetil, tacrolimus, and methylprednisolone. RESULTS Intraoperative, the allograft had excellent capillary refill and strong Doppler signals after revascularization. Operative reinterventions on postoperative days (PODs) 2 and 13 were required for hematoma evacuation and skin eschar debridement. At 3 weeks, no anastomotic leaks were detected on urethrogram, and the catheter was removed. Steroid resistant-rejection developed on POD 28 (Banff I), progressed by POD 32 (Banff III), and required a repeat course of methylprednisolone and antithymocyte globulin. At 7 months, the patient has recovered partial sensation of the penile shaft and has spontaneous penile tumescence. Our patient reports increased overall health satisfaction, dramatic improvement of self-image, and optimism for the future. CONCLUSIONS We have shown that it is feasible to perform penile transplantation with excellent results. Furthermore, this experience demonstrates that penile transplantation can be successfully performed with conventional immunosuppression. We propose that our successful penile transplantation pilot experience represents a proof of concept for an evolution in reconstructive transplantation.
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Suskin ZD, Giordano JJ. Body -to-head transplant; a "caputal" crime? Examining the corpus of ethical and legal issues. Philos Ethics Humanit Med 2018; 13:10. [PMID: 30005672 PMCID: PMC6045868 DOI: 10.1186/s13010-018-0063-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023] Open
Abstract
Neurosurgeon Sergio Canavero proposed the HEAVEN procedure - i.e. head anastomosis venture - several years ago, and has recently received approval from the relevant regulatory bodies to perform this body-head transplant (BHT) in China. The BHT procedure involves attaching the donor body (D) to the head of the recipient (R), and discarding the body of R and head of D. Canavero's proposed procedure will be incredibly difficult from a medical standpoint. Aside from medical doubt, the BHT has been met with great resistance from many, if not most bio- and neuroethicists.Given both the known challenges and unknown outcomes of HEAVEN, several important neuroethical and legal questions have emerged should Canavero be successful, including: (1) What are the implications for transplantology in the U.S., inclusive of issues of expense, distributive justice, organizational procedures, and the cost(s) of novel insight(s)? (2) How do bioethical and neuroethical principles, and legal regulations of human subject research apply? (3) What are the legal consequences for Canavero (or any other surgeon) performing a BHT? (4) What are the tentative implications for the metaphysical and legal identity of R should they survive post-BHT? These questions are analyzed, issues are identified, and several solutions are proposed in an attempt to re-configure HEAVEN into a safe, clinically effective, and thus (more) realistically viable procedure.Notably, the permissibility of conducting the BHT in China fosters additional, important questions, focal to (1) whether Western ethics and professional norms be used to guide the BHT - or any neuroscientific research and its use - in non-Western countries, such as China; (2) if the models of responsible conduct of research are identical, similar, or applicable to the intent and conduct of research in China; and (3) what economic and political implications (for China and other countries) are fostered if/when such avant garde techniques are successful.These questions are discussed as a further impetus to develop a globally applicable neuroethical framework that would enable both local articulation and cosmopolitan inquiry and oversight of those methods and approaches deemed problematic, if and when rendered in more international settings.
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Affiliation(s)
- Zaev D. Suskin
- Harvard Medical School Center for Bioethics, 641 Huntington Avenue, Boston, MA 02115 USA
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20057 USA
- Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Bldg. D, Rm 238, 4000 Reservoir Road NW, Washington, DC, 20057 USA
| | - James J. Giordano
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20057 USA
- Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Bldg. D, Rm 238, 4000 Reservoir Road NW, Washington, DC, 20057 USA
- Departments of Neurology and Biochemistry, Georgetown University Medical Center, 3900 Reservoir Road NW, Washington, DC, 20057 USA
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Radu CA, Fischer S, Diehm Y, Hetzel O, Neubrech F, Dittmar L, Kleist C, Gebhard MM, Terness P, Kneser U, Kiefer J. The combination of mitomycin-induced blood cells with a temporary treatment of ciclosporin A prolongs allograft survival in vascularized composite allotransplantation. Langenbecks Arch Surg 2017; 403:83-92. [PMID: 28823033 DOI: 10.1007/s00423-017-1616-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 08/10/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Vascularized composite allotransplantation (VCA) is a rapidly expanding field of transplantation and provides a potential treatment for complex tissue defects. Peripheral blood mononuclear cells (PBMCs) shortly incubated with the antibiotic and chemotherapeutic agent mitomycin C (MMC) can suppress allogeneic T cell response and control allograft rejection in various organ transplantation models. MMC-incubated PBMCs (MICs) are currently being tested in a phase I clinical trial in kidney transplant patients. Previous studies with MICs in a complex VCA model showed the immunomodulatory potential of these cells. The aim of this study is to optimize and evaluate the use of MICs in combination with a standard immunosuppressive drug in VCA. METHODS Fully mismatched rats were used as hind limb donors [Lewis (RT11)] and recipients [Brown-Norway (RT1n)]. Sixty allogeneic hind limb transplantations were performed in six groups. Group A received donor-derived MICs combined with a temporary ciclosporin A (CsA) treatment. Group B received MICs in combination with a temporarily administered reduced dose of CsA. Group C served as a control and received a standard CsA dose temporarily without an additional administration of MICs, whereas Group D was solely medicated with a reduced CsA dose. Group E received no immunosuppressive therapy, neither CsA nor MICs. Group F was given a continuous standard immunosuppressive regimen consisting of CsA and prednisolone. The endpoint of the study was the onset of allograft rejection which was assessed clinically and histologically. RESULTS In group A and B, the rejection-free interval of the allograft was significantly prolonged to an average of 23.1 ± 1.7 and 24.7 ± 1.8 days compared to the corresponding control groups (p < 0.01). Rejection in groups C, D, and E was noted after 14.3 ± 1.1, 7.8 ± 0.7, and 6.9 ± 0.6 days. No rejection occurred in control group F during the follow-up period of 100 days. No adverse events have been noted. CONCLUSION The findings of this study show that the combination of MICs with a temporary CsA treatment significantly prolongs the rejection-free interval in a complex VCA model. The combination of MICs with CsA showed no adverse events such as graft-versus-host disease. MICs, which are generated by a simple and reliable in vitro technique, represent a potential therapeutic tool for prolonging allograft survival through immunomodulation.
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Affiliation(s)
- Christian Andreas Radu
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071, Ludwigshafen, Germany
| | - Sebastian Fischer
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071, Ludwigshafen, Germany
| | - Yannick Diehm
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071, Ludwigshafen, Germany
| | - Otto Hetzel
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071, Ludwigshafen, Germany
| | - Florian Neubrech
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071, Ludwigshafen, Germany
| | - Laura Dittmar
- Transplantation Immunology, Institute for Immunology, University of Heidelberg, Heidelberg, Germany
| | - Christian Kleist
- Transplantation Immunology, Institute for Immunology, University of Heidelberg, Heidelberg, Germany.,Department of Nuclear Medicine, University of Heidelberg, Heidelberg, Germany
| | - Martha Maria Gebhard
- Department of Experimental Surgery, University of Heidelberg, Heidelberg, Germany
| | - Peter Terness
- Transplantation Immunology, Institute for Immunology, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071, Ludwigshafen, Germany
| | - Jurij Kiefer
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071, Ludwigshafen, Germany.
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Abstract
On November 27, 2005, Isabelle Dinoire underwent the world's first partial face transplant in Amiens (France) after a dog attack had left her face severely disfigured. The abrupt surgical leap found the medical community and society unprepared to deal with the scientific, ethical, and societal implications of a surgical procedure that was striving to transition from sci-fi novels to science. Today, 10 years and over 35 transplants later, public opinion has become accustomed to the concept of "face restoration" through transplantation. However, face transplantation is far from being a safe "routine" surgery and the science behind it is still mostly unknown. Patients and multidisciplinary teams of physicians confront daily medical challenges, life-threatening risks, and personal struggle that only in part come to light. Could (or should) this be the laborious, uncertain, and high-risk trajectory of disruptive medical innovation? Over the last decade, some medical discoveries and surgical advancements in the field have been closely accompanied by partial regulatory frameworks, intense ethical discussions, and meaningful changes in social beliefs across cultures and continents. Yet, a very long way is to come and the questions we still have today greatly outweigh the answers we can offer. Here, we take the chance of the 10-year anniversary of face transplantation to reflect on the path traveled and to look forward to the challenges lying ahead.
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Abstract
Reconstruction of severe facial deformities poses a unique surgical challenge: restoring the aesthetic form and function of the face. Facial transplantation has emerged over the last decade as an option for reconstruction of these defects in carefully selected patients. As the world experience with facial transplantation grows, debate remains regarding whether such a highly technical, resource-intensive procedure is warranted, all to improve quality of life but not necessarily prolong it. This article reviews the current state of facial transplantation with focus on the current controversies and challenges, with particular attention to issues of technique, immunology, and ethics.
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Affiliation(s)
- Jack E Russo
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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Furr A, Hardy MA, Barret JP, Barker JH. Surgical, ethical, and psychosocial considerations in human head transplantation. Int J Surg 2017; 41:190-195. [PMID: 28110028 PMCID: PMC5490488 DOI: 10.1016/j.ijsu.2017.01.077] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/11/2017] [Accepted: 01/14/2017] [Indexed: 12/14/2022]
Abstract
Transplanting a head and brain is perhaps the final frontier of organ transplantation. The goal of body-to-head transplantation (BHT) is to sustain the life of individuals who suffer from terminal disease, but whose head and brain are healthy. Ideally BHT could provide a lifesaving treatment for several conditions where none currently exists. BHT is no ordinary experiment, to transfer a head to another body involves extraordinarily complex medical challenges as well as ethical and existential dilemmas that were previously confined to the imagination of writers of fiction. The possibility of replacing an incurably ill body with a healthy one tests not only our surgical limits, but also the social and psychological boundaries of physical life and alters what we recognize life to be. The purpose of this target article, the complementary manuscript focused on immunological issues in BHT, and the accompanying Commentaries by scholars and practitioners in medicine, immunology, and bioethics is to review major surgical and psychosocial-ethical and immunological considerations surrounding body-to-head transplantation. We hope that together these ideas will provide readers with a comprehensive overview of the possibilities and challenges associated with BHT and initiate professional discussion and debate through which this new frontier in medicine is considered and approached.
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Affiliation(s)
- Allen Furr
- Haley Center 7018, Auburn University, Auburn, AL, 36849, USA.
| | - Mark A Hardy
- Department of Surgery, Columbia University College of Physicians and Surgeons, 161 Fort, Washington Ave., Herbert Irving Pavilion 5-549, New York, NY, 10032, USA.
| | - Juan P Barret
- University Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - John H Barker
- Frankfurt Initiative for Regenerative Medicine, Experimental Orthopedics & Trauma Surgery, J.W. Goethe-University, Friedrichsheim Orthopedic Hospital, Haus 97 B, 1OG, Marienburgstr. 2, 60528, Frankfurt/Main, Germany.
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Theodorakopoulou E, Meghji S, Pafitanis G, Mason KA. A review of the world's published face transplant cases: ethical perspectives. Scars Burn Heal 2017; 3:2059513117694402. [PMID: 29799566 PMCID: PMC5965321 DOI: 10.1177/2059513117694402] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The highly publicised case of the first ever partial facial transplant in 2005 sparked fierce ethical debates, moral arguments and strong opinions, both within the medical community as well as the general public and mass media. As more patients have undergone facial transplantation over the last decade, some of this initial scepticism has given way to a wider acceptance of this significant reconstructive development. However, despite an improved understanding of the perioperative technicalities and postoperative perils, the risks remain significant and the long-term outcomes are still largely unknown. This article examines the major ethical challenges that have accompanied facial allo-transplantation since its inception. We discuss these ethical dilemmas in the context of the patients, donor families, healthcare professionals and society as a whole, while evaluating some of the emerging evidence and outcomes associated with the physical and psycho-emotional risks linked to this procedure.
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Affiliation(s)
| | - Sheneen Meghji
- Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
| | - Georgios Pafitanis
- The Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Katrina A Mason
- The Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
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Siemionow M. The miracle of face transplantation after 10 years. Br Med Bull 2016; 120:5-14. [PMID: 27941036 DOI: 10.1093/bmb/ldw045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/06/2016] [Accepted: 10/26/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION At the 10th year anniversary of the first face transplantation, there are currently 36 patients worldwide, who are the recipients of faces coming from human donors. AREAS OF AGREEMENT Despite the initial debates and ethical concerns, face transplantation became a clinical reality with satisfactory functional outcomes. AREAS OF CONTROVERSY The areas of controversy still include the impact of lifelong immunosuppression on otherwise healthy patients as well as the selection process of face transplant candidates. GROWING POINTS Other concerns include financial support for this new generation of transplants as well as social reintegration and patients return to work after face transplantation. AREAS TIMELY FOR DEVELOPING RESEARCH Based on over 20 years of research experience in the field of vascularized composite allotransplantation, and clinical experience as a leading surgeon of the US first face transplantation, this review will summarize the well-known facts as well as unexpected outcomes and challenges of face transplantation.
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Affiliation(s)
- Maria Siemionow
- Department of Orthopaedics, University of Illinois, Chicago, IL, USA
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Coriddi M, Janis J. Face Transplantation: Medical Considerations. CURRENT TRANSPLANTATION REPORTS 2016. [DOI: 10.1007/s40472-016-0123-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Radu CA, Kiefer J, Gebhard MM, Bigdeli AK, Schmidt VJ, Germann G, Lehnhardt M, Terness P, Kneser U, Kremer T. Local administration of Mitomycin-C-Treated peripheral blood mononuclear cells (PBMCs) prolongs allograft survival in vascularized composite allotransplantation. Microsurgery 2015; 36:417-425. [DOI: 10.1002/micr.30003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/15/2015] [Accepted: 10/23/2015] [Indexed: 02/02/2023]
Affiliation(s)
- Christian Andreas Radu
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Jurij Kiefer
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Martha Maria Gebhard
- Department of Experimental Surgery; University of Heidelberg, Heidelberg; Germany
| | - Amir Khosrow Bigdeli
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Volker Jürgen Schmidt
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Guenter Germann
- Department of Hand- Plastic- and Reconstructive Surgery, Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Ethianum Heidelberg Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery; Burn Center, Sarcoma Reference Center, BG-University Hospital Bergmannsheil; Bochum Germany
| | - Peter Terness
- Department of Transplant Immunology; Institute for Immunology, University of Heidelberg, Heidelberg; Germany
| | - Ulrich Kneser
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
| | - Thomas Kremer
- Department of Hand- Plastic- and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery-University of Heidelberg, Heidelberg; Germany
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Kueckelhaus M, Fischer S, Seyda M, Bueno EM, Aycart MA, Alhefzi M, ElKhal A, Pomahac B, Tullius SG. Vascularized composite allotransplantation: current standards and novel approaches to prevent acute rejection and chronic allograft deterioration. Transpl Int 2015; 29:655-62. [PMID: 26265179 DOI: 10.1111/tri.12652] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/10/2015] [Accepted: 07/30/2015] [Indexed: 12/18/2022]
Abstract
The advent of more potent immunosuppressants led to the first successful human upper extremity transplantation in 1998. At this time, >100 upper extremity transplants, 30 face transplants, and a variety of other vascularized composite allotransplantation (VCA) procedures have been performed around the world. VCA recipients present unique challenges for transplantation. The incidence of acute rejection exceeds 80% in hand and face transplantation and is well documented, whereas reports about antibody-mediated rejection and chronic rejection remain scarce. Immunosuppression protocols commonly used at US centers are derived from solid organ transplantation protocols. Novel approaches to minimize rejections in VCA may include improved HLA matching and considerations toward cytomegalovirus infection status. New graft preservation techniques may decrease immunogenicity prior to transplant. Novel monitoring methods such as valid biomarkers, ultrasound biomicroscopy, and sentinel flaps may enable earlier diagnosis of rejection. Cell-based therapies are being explored to achieve immunosuppressive regimen minimization or even tolerance induction. The efficacy of local immunosuppression in clinical VCA remains controversial. In conclusion, although immunosuppressive strategies adapted from SOT have demonstrated good midterm results, focusing on the unique features of VCA grafts may enable additional, more specific treatment strategies in the future and improved long-term graft outcomes.
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Affiliation(s)
- Maximilian Kueckelhaus
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Sebastian Fischer
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Plastic Surgery, BG University Hospital Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
| | - Midas Seyda
- Division of Transplant Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ericka M Bueno
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mario A Aycart
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Muayyad Alhefzi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abdallah ElKhal
- Division of Transplant Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan G Tullius
- Division of Transplant Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Toso SM, Menzel K, Motzkus Y, Klein M, Menneking H, Raguse JD, Nahles S, Hoffmeister B, Adolphs N. Anaplastology in times of facial transplantation: Still a reasonable treatment option? J Craniomaxillofac Surg 2015; 43:1049-53. [PMID: 26105813 DOI: 10.1016/j.jcms.2015.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/25/2015] [Accepted: 05/20/2015] [Indexed: 11/24/2022] Open
Abstract
Optimum functional and aesthetic facial reconstruction is still a challenge in patients who suffer from inborn or acquired facial deformity. It is known that functional and aesthetic impairment can result in significant psychosocial strain, leading to the social isolation of patients who are affected by major facial deformities. Microvascular techniques and increasing experience in facial transplantation certainly contribute to better restorative outcomes. However, these technologies also have some drawbacks, limitations and unsolved problems. Extensive facial defects which include several aesthetic units and dentition can be restored by combining dental prostheses and anaplastology, thus providing an adequate functional and aesthetic outcome in selected patients without the drawbacks of major surgical procedures. Referring to some representative patient cases, it is shown how extreme facial disfigurement after oncological surgery can be palliated by combining intraoral dentures with extraoral facial prostheses using individualized treatment and without the need for major reconstructive surgery.
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Affiliation(s)
- Sabine Maria Toso
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Surgical Navigation, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Kerstin Menzel
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Surgical Navigation, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Yvonne Motzkus
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Surgical Navigation, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Martin Klein
- Fachklinik Hornheide, Department of Oral and Maxillofacial Surgery, Dorbaumstrasse 300, 48157 Münster, Germany
| | - Horst Menneking
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Surgical Navigation, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jan-Dirk Raguse
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Surgical Navigation, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Susanne Nahles
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Surgical Navigation, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Bodo Hoffmeister
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Surgical Navigation, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nicolai Adolphs
- Department of Craniomaxillofacial Surgery (Head: Prof. Dr. med. Dr. med. dent. Bodo Hoffmeister), Surgical Navigation, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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Abstract
BACKGROUND Skin biopsies are critical for histologic evaluation of rejection and proper treatment after facial allotransplantation. Many facial allografts provide only limited skin area, and frequent biopsies may also compromise aesthetic outcome. Sentinel flaps, recovered as free fasciocutaneous radial forearm flaps, have been used for remote-site rejection monitoring. They maintain their axial blood supply, similar to facial allografts. The correlation between facial allografts and sentinel flaps in cases of rejection is presented. METHODS The authors analyzed the experience of the Boston team's use of four sentinel flaps. Rejection was evaluated and results were compared for each time point. Sentinel flaps were used as functional flaps whenever possible. RESULTS Results showed a reliable correlation between biopsy specimens taken from the facial allograft and sentinel flaps. During severe rejection episodes in 100 percent of biopsy pairs, both sites displayed a similar grade of rejection. In one case, clinical findings suggested rejection in the facial allograft but were unraveled as rosacea, because clinically there was no rejection displayed in the sentinel flap. CONCLUSIONS The sentinel flap shows a reliable correlation to the facial allograft in cases of severe rejection, therefore providing a valuable tool for rejection monitoring in facial allotransplantation. Advantages of using these flaps include the avoidance of further surgical procedures to the primary vascularized composite allotransplant, additional use of the sentinel flap to repair damaged nonfacial sites, and its utility as both a clinical and histopathologic barometer of rejection and predictor of the potential existence of facial dermatitis unrelated to rejection. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Wall A, Bueno E, Pomahac B, Treister N. Intraoral features and considerations in face transplantation. Oral Dis 2015; 22:93-103. [DOI: 10.1111/odi.12301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 11/27/2022]
Affiliation(s)
- A Wall
- Department of Oral Medicine and Dentistry; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - E Bueno
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - B Pomahac
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - N Treister
- Department of Oral Medicine and Dentistry; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Oral Medicine, Infection and Immunity; Harvard School of Dental Medicine; Boston MA USA
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Fischer S, Kueckelhaus M, Pauzenberger R, Bueno EM, Pomahac B. Functional outcomes of face transplantation. Am J Transplant 2015; 15:220-33. [PMID: 25359281 DOI: 10.1111/ajt.12956] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 01/25/2023]
Abstract
In this study we provide a compilation of functional impairments before and improvements after face transplantation (FT) of five FT recipients of our institution and all FTs reported in current literature. Functional outcome included the ability to smell, breath, eat, speak, grimace and facial sensation. Before FT, all our patients revealed compromised ability to breath, eat, speak, grimace and experience facial sensation. The ability to smell was compromised in two of our five patients. Two patients were dependent on tracheostomy and one on gastrostomy tubes. After FT, all abilities were significantly improved and all patients were independent from artificial air airways and feeding tubes. Including data given in current literature about the other 24 FT recipients in the world, the abilities to smell, eat and feel were enhanced in 100% of cases, while the abilities of breathing, speaking and facial expressions were ameliorated in 93%, 71% and 76% of cases, respectively. All patients that required gastrostomy and 91% of patients depending on tracheostomy were decannulated after FT. Unfortunately, outcomes remain unreported in all other cases and therefore we are unable to comment on improvements.
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Affiliation(s)
- S Fischer
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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Sarwer DB, Ritter S, Reiser K, Spitzer JC, Baumann BM, Patel SN, Mazzarelli AJ, Levin LS, Doll S, Caplan AL. Attitudes Toward Vascularized Composite Allotransplantation of the Hands and Face in an Urban Population. ACTA ACUST UNITED AC 2014. [DOI: 10.4161/23723505.2014.975021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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43
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The value of innovation: face and hand transplantation programs at Brigham and Women's Hospital. Plast Reconstr Surg 2014; 134:178e-179e. [PMID: 25028846 DOI: 10.1097/prs.0000000000000464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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