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Kodali NA, Janarthanan R, Sazoglu B, Demir Z, Dirican O, Zor F, Kulahci Y, Gorantla VS. A World Update of Progress in Lower Extremity Transplantation: What's Hot and What's Not. Ann Plast Surg 2024; 93:107-114. [PMID: 38885168 DOI: 10.1097/sap.0000000000004035] [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: 06/20/2024]
Abstract
ABSTRACT The field of vascularized composite allotransplantation (VCA) is the new frontier of solid organ transplantation (SOT). VCA spans life-enhancing/life-changing procedures such as upper extremity, craniofacial (including eye), laryngeal, tracheal, abdominal wall, penis, and lower extremity transplants. VCAs such as uterus transplants are life giving unlike any other SOT. Of all VCAs that have shown successful intermediate- to long-term graft survival with functional and immunologic outcomes, lower extremity VCAs have remained largely underexplored. Lower extremity transplantation (LET) can offer patients with improved function compared to the use of conventional prostheses, reducing concerns of phantom limb pain and stump complications, and offer an option for eligible amputees that either fail prosthetic rehabilitation or do not adapt to prosthetics. Nevertheless, these benefits must be carefully weighed against the risks of VCA, which are not trivial, including the adverse effects of lifelong immunosuppression, extremely challenging perioperative care, and delayed nerve regeneration. There have been 5 lower extremity transplants to date, ranging from unilateral or bilateral to quadrimembral, progressively increasing in risk that resulted in fatalities in 3 of the 5 cases, emphasizing the inherent risks. The advantages of LET over prosthetics must be carefully weighed, demanding rigorous candidate selection for optimal outcomes.
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Affiliation(s)
- Naga Anvesh Kodali
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC
| | - Ramu Janarthanan
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Bedreddin Sazoglu
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC
| | - Zeynep Demir
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC
| | - Omer Dirican
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC
| | - Fatih Zor
- Department of Plastic Surgery, Indiana University, Indianapolis, IN
| | - Yalcin Kulahci
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC
| | - Vijay S Gorantla
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, NC
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Barrow B, Diep GK, Berman ZP, Boczar D, Lee O, Salinero L, Howard R, Trilles J, Rodriguez Colon R, Rodriguez ED. Immunologic Outcomes in Cross-Sex Solid Organ Transplants: A Systematic Review and Meta-Analysis to Inform Vascularized Composite Allotransplantation. Plast Reconstr Surg 2024; 153:839-851. [PMID: 37224220 DOI: 10.1097/prs.0000000000010757] [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: 05/26/2023]
Abstract
BACKGROUND Of nearly 90 hand and 50 face transplant recipients, only five have received a cross-sex vascularized composite allotransplantation (CS-VCA). CS-VCA has the potential to expand the donor pool and has been proven anatomically feasible and ethically acceptable in previous studies. However, there is a lack of immunologic data. This study evaluated the immunologic feasibility of CS-VCA through analysis of the solid organ transplant literature, given the paucity of CS-VCA data. The authors hypothesize that rates of acute rejection (AR) and graft survival (GS) in CS versus same-sex (SS) solid organ transplantation are similar. METHODS A systematic review and meta-analysis were performed. Studies comparing GS or AR episodes in CS and SS adult kidney (KT) and liver transplant (LT) populations were included. Odds ratios were calculated for overall GS and AR for all SS and CS transplant combinations [male-to-female (MTF), female-to-male, and overall]. RESULTS A total of 693 articles were initially identified with 25 included in the meta-analysis. No significant difference in GS was noted between SS-KT versus CS-KT [OR, 1.04 (95% CI, 1.00 to 1.07); P = 0.07), SS-KT versus MTF-KT [OR, 0.97 (95% CI, 0.90 to 1.04); P = 0.41), and SS-LT versus MTF-LT [OR, 0.95 (95% CI, 0.91 to 1.00); P = 0.05). No significant difference in AR was noted between SS-KT versus MTF-KT [OR, 0.99 (95% CI, 0.96 to 1.02); P = 0.57), SS-LT versus CS-LT [OR, 0.78 (95% CI, 0.53 to 1.16); P = 0.22], or SS-LT versus female-to-male LT [OR, 1.03 (95% CI, 0.95 to 1.12); P = 0.47]. For the remaining pairings, GS was significantly increased and AR was significantly decreased in the SS transplants. CONCLUSIONS Published data suggest immunologic feasibility of CS-KT and CS-LT with the potential for generalization to the VCA population. CLINICAL RELEVANCE STATEMENT In theory, CS-VCA could expand the potential donor pool, ultimately leading to decreased wait times for recipients and improve the likelihood of establishing a immunologically favorable donor-recipient match.
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Affiliation(s)
- Brooke Barrow
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Gustave K Diep
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Zoe P Berman
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Daniel Boczar
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Olive Lee
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Lauren Salinero
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Rachel Howard
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Jorge Trilles
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | | | - Eduardo D Rodriguez
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
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The First Successful Combined Full Face and Bilateral Hand Transplant. Plast Reconstr Surg 2022; 150:414-428. [PMID: 35674521 DOI: 10.1097/prs.0000000000009369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vascularized composite allotransplantation has redefined the frontiers of plastic and reconstructive surgery. At the cutting edge of this evolving paradigm, the authors present the first successful combined full face and bilateral hand transplant. METHODS A 21-year-old man presented for evaluation with sequelae of an 80 percent total body surface area burn injury sustained after a motor vehicle accident. The injury included full face and bilateral upper extremity composite tissue defects, resulting in reduced quality of life and loss of independence. Multidisciplinary evaluation confirmed eligibility for combined face and bilateral hand transplantation. The operative approach was validated through 11 cadaveric rehearsals utilizing computerized surgical planning. Institutional review board and organ procurement organization approvals were obtained. The recipient, his caregiver, and the donor family consented to the procedure. RESULTS Combined full face (i.e., eyelids, ears, nose, lips, and skeletal subunits) and bilateral hand transplantation (i.e., forearm level) was performed over 23 hours on August 12 to 13, 2020. Triple induction and maintenance immunosuppressive therapy and infection prophylaxis were administered. Plasmapheresis was necessary postoperatively. Minor revisions were performed over seven subsequent operations, including five left upper extremity, seven right upper extremity, and seven facial secondary procedures. At 8 months, the patient was approaching functional independence and remained free of acute rejection. He had significantly improved range of motion, motor power, and sensation of the face and hand allografts. CONCLUSIONS Combined face and bilateral hand transplantation is feasible. This was the most comprehensive vascularized composite allotransplantation procedure successfully performed to date, marking a new milestone in plastic and reconstructive surgery for patients with otherwise irremediable injuries.
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Amin KR, Fildes JE. Bionic Prostheses: The Emerging Alternative to Vascularised Composite Allotransplantation of the Limb. Front Surg 2022; 9:873507. [PMID: 35599802 PMCID: PMC9122218 DOI: 10.3389/fsurg.2022.873507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
Twenty years have surpassed since the first vascularised composite allotransplantation (VCA) of the upper limb. This is an opportunity to reflect on the position of VCA as the gold standard in limb reconstruction. The paucity of recipients, tentative clinical outcomes, and insufficient scientific progress question whether VCA will remain a viable treatment option for the growing numbers of amputees. Bionic technology is advancing at a rapid pace. The prospect of widely available, affordable, safely applied prostheses with long-standing functional benefit is appealing. Progress in the field stems from the contributions made by engineering, electronic, computing and material science research groups. This review will address the ongoing reservations surrounding VCA whilst acknowledging the future impact of bionic technology as a realistic alternative for limb reconstruction.
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Affiliation(s)
- Kavit R. Amin
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Correspondence: Kavit R. Amin ;
| | - James E. Fildes
- The Ex-Vivo Research Centre CIC, Alderley Park, Macclesfield, United Kingdom
- The Healthcare Technologies Institute, School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom
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Hsieh YH, Lee MC, Hsu CC, Chen SH, Lin YT, Lin CH, Lin CH. Popliteal Artery Injury After Fracture and/or Dislocation of the Knee: Risk Stratification for Revascularization Outcome. Ann Plast Surg 2022; 88:S50-S55. [PMID: 35225847 DOI: 10.1097/sap.0000000000003076] [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: 11/26/2022]
Abstract
BACKGROUND Managing complex knee trauma involving both vascular and osseous injuries is challenging, yet the available guidelines for efficient popliteal artery injury management after high-velocity blunt knee trauma remain conflicting and inconsistent. In this study, the authors aim to identify the risk factors associated with delayed limb amputation and ischemic muscular sequela postrevascularization. Furthermore, we propose a treatment algorithm to improve the limb salvage rate. METHODS Patients who presented with traumatic popliteal artery injury resulting in vessel occlusion or rupture, followed by fracture and/or dislocation of the knee from January 2008 to December 2013, were included for retrospective review. RESULTS Overall delayed amputation rate was 24% (7/29) and 16% (4/25) after successful revascularization. Mangled Extremity Severity Score is higher in the delayed amputation group than the limb-salvaged group (P = 0.02). Higher-impact force (P = 0.03), ischemic limb on presentation (P = 0.03), prolonged ischemia time (P = 0.04), unstable hemodynamics (P = 0.01), longer operation time (P = 0.04), and prolonged intensive care unit stay (P = 0.03) are risk factors of delayed amputation. Longer ischemia time (P = 0.04) and length of popliteal artery injury (P = 0.02) are associated with ischemic muscular sequela. CONCLUSIONS Mangled Extremity Severity Score is a reliable predictor of limb salvage. An algorithmic approach may improve the outcome of popliteal artery injury after high-velocity blunt knee trauma.
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Affiliation(s)
- Yun-Huan Hsieh
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
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Wells MW, Rampazzo A, Papay F, Gharb BB. Two Decades of Hand Transplantation: A Systematic Review of Outcomes. Ann Plast Surg 2022; 88:335-344. [PMID: 35113506 DOI: 10.1097/sap.0000000000003056] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Hand transplantation for upper extremity amputation provides a unique treatment that restores form and function, which may not be achieved by traditional reconstruction and prosthetics. However, despite enhancing quality of life, hand transplantation remains controversial, because of immunological complications, transplant rejection, and medication effects. This systematic literature review sought to collect information on current experiences and outcomes of hand transplants to determine the efficacy and utility of hand transplants. The databases PubMed, Scopus, and Embase were analyzed with combinations of "hand" or "upper extremity" or "arm" and "transplant" or "allograft," with information collected on recipient characteristics, details of transplant, immunological outcomes, functional outcomes, and complications. Functional outcomes, as measured by Disabilities of Arm, Shoulder and Hand score, were compared between patient groups using Wilcoxon signed-rank test or 1-way analysis of variance test and post hoc Tukey test. Within the 108 articles that fulfilled inclusion and exclusion criteria, there were 96 patients with 148 hand transplants. There were 57 patients who experienced acute rejection and 5 patients with chronic rejection. Disabilities of the Arm, Shoulder and Hand scores significantly decreased after hand transplantation and were significantly lower for distal transplants compared with proximal transplants. There were 3 patients with concurrent face transplantation and 2 patients with simultaneous leg transplants. Sixteen patients experienced amputation of the hand transplant, and there were 5 deaths. This study found that hand transplantation provides significant restoration of function and form, especially for proximal transplants. Reduction in complications, such as rejection and amputation, can be achieved by decreasing medication cost and patient education.
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Affiliation(s)
- Michael W Wells
- From the Case Western Reserve University, School of Medicine
| | | | - Francis Papay
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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Haug V, Kollar B, Endo Y, Kadakia N, Veeramani A, Kauke M, Tchiloemba B, Klasek R, Pomahac B. Comparison of Acellular Solutions for Ex-situ Perfusion of Amputated Limbs. Mil Med 2021; 185:e2004-e2012. [PMID: 33377496 DOI: 10.1093/milmed/usaa160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Hypothermic ex-situ machine perfusion (MP) has been shown to be a promising alternative to static cold storage (SCS) for preservation of solid organs for transplantation and vascularized composite allotransplantation. Perfusion with blood-based perfusion solutions in austere environments is problematic due to their need for appropriate storage and short shelf life, making it impractical for military and emergency use. Acellular perfusion has been shown to be effective, but the ideal perfusate solution for MP of amputated limbs is yet to be determined. The purpose of this study is to evaluate the efficacy of alternative perfusate solutions, such as dextran-enriched Phoxilium, Steen, and Phoxilium in ex-vivo hypothermic MP of amputated limbs in a porcine model. MATERIALS AND METHODS Amputated forelimbs from Yorkshire pigs (n = 8) were preserved either in SCS (n = 2) at 4°C for 12 hours or machine-perfused at 10°C for 12 hours with oxygenated perfusion solutions (n = 6) at a constant flow rate. The perfusates used include modified Steen-solution, Phoxilium (PHOX), or Phoxilium enriched with dextran-40 (PHODEX). The perfusate was exchanged after 1 and 6 hours of perfusion. Machine data were recorded continuously. Perfusate samples for clinical chemistry, blood gas analysis, and muscle biopsies were procured at specific timepoints and subsequently analyzed. In this semi in-vivo study, limb replantation has not been performed. RESULTS After amputation, every limb was successfully transferred and connected to our perfusion device. The mean total ischemia time was 77.5 ± 5.24 minutes. The temperature of the perfusion solution was maintained at 10.18 ± 2.01°C, and perfusion pressure at 24.48 ± 10.72 mmHg. Limb weight increased by 3% in the SCS group, 36% in the PHODEX group, 25% in the Steen group, and 58% in the PHOX group after 12 hours. This increase was significant in the PHOX group compared with the SCS group. All perfusion groups showed a pressure increase of 10.99 mmHg over time due to edema. The levels of HIF-1a decreased over time in all groups except the Steen and the PHODEX group. The biomarkers of muscle injury in the perfusate samples, such as creatine kinase and lactate-dehydrogenase, showed a significant difference between groups, with highest values in the PHODEX group. No significant differences were found in the results of the blood gas analysis. CONCLUSION With the exception of significantly higher levels of creatine kinase and lactate dehydrogenase, MP with dextran-enriched Phoxilium provides similar results as that of the commercially available perfusates such as Steen, without the need for cold storage, and at circa 5% of the cost of the Steen solution. Further large-scale replantation studies are necessary to evaluate the efficacy of dextran-enriched Phoxilium as an alternate perfusate solution.
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Affiliation(s)
- Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Strasse 13, Ludwigshafen am Rhein 67071, Germany
| | - Branislav Kollar
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Center, Freiburg 79106, Germany
| | - Yori Endo
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Nikita Kadakia
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.,Riverside School of Medicine, University of California, 92521 UCR Botanic Gardens Road, Riverside, CA 92507, USA
| | - Anamika Veeramani
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Martin Kauke
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Bianief Tchiloemba
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Robin Klasek
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Anesthetic Considerations in Facial Transplantation: Experience at NYU Langone Health and Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2955. [PMID: 32983760 PMCID: PMC7489595 DOI: 10.1097/gox.0000000000002955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/08/2020] [Indexed: 01/18/2023]
Abstract
Anesthetic considerations are integral to the success of facial transplantation (FT), yet limited evidence exists to guide quality improvement. This study presents an institutional anesthesia protocol, defines reported anesthetic considerations, and provides a comprehensive update to inform future directions of the field.
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Monné Cuevas P, Borrás Correa A, Vidal Fortuny E, Ángeles Diaz Vela M, Calvo Sanz J. Traumatic quadruple amputee rehabilitation: from amputation to prosthetic functionality: a case report. Disabil Rehabil Assist Technol 2019; 16:112-118. [PMID: 31373523 DOI: 10.1080/17483107.2019.1644675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Traumatic quadruple amputations limit daily living activities; however, the current literature regarding rehabilitation treatment for multi-limb amputations is scant. The patient showed adaptation to prosthetic fittings, acquiring a level of functional independence that enabled the patient to lead a nearly independent life. METHODS The patient's therapeutic intervention was divided into a pre-prosthetic phase, which consisted of functional physical adaptation to the amputation and preparation for the prostheses, and a prosthetic phase, in which different myoelectric and microprocessor limb prostheses were integrated to be used functionally. Its functional use was favored by the training with contact electromyography feedback carried out with the Biometrics E-Link System® for the upper extremities that has made it possible to obtain many grip options in a natural way, for the lower extremities the use of the intelligent passive prostheses has overcome the functional capacity achieved in this type of patients referenced in the literature who had used prostheses of previous generations such as mechanical passive prostheses. RESULTS With rehabilitation, the patient showed improvements in the following scales and questionnaires (initial vs. final values): Disabilities of the Arm, Shoulder, and Hand Questionnaire; Functional Independence Measure; Berg Balance Scale; Locomotor Capabilities Index in Amputees (an assessment of overall motor capacity); and Special Interest Group in Amputee Medicine scale (an assessment of the degree of mobility). CONCLUSIONS The patient's age, psychological status, and family and personal support, in addition to technical and economic resources used for next-generation prostheses adapted to this clinical case, were crucial for his progress. IMPLICATIONS FOR REHABILITATION The use of next-generation myoelectric and microprocessor prostheses makes it possible to achieve greater end functionality in quadruple amputees. Proximal amputation levels present greater difficulty in achieving good functionality. Early and intensive rehabilitation could favour and contribute towards improving psychological states. Age, psychological status, and pain management are aspects to take into account during the rehabilitation process.
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Affiliation(s)
- Pol Monné Cuevas
- Rehabilitation Department, Hospital Asepeyo Sant Cugat del Vallès, Barcelona, Spain
| | - Andrea Borrás Correa
- Physical and Rehabilitation Medicine Service, Hospital de Sant Joan Despí Moisès Broggi (Consorci Sanitari Integral), Barcelona, Spain
| | - Eloïna Vidal Fortuny
- Rehabilitation Department, Hospital Asepeyo Sant Cugat del Vallès, Barcelona, Spain
| | | | - Jordi Calvo Sanz
- Rehabilitation Department, Hospital Asepeyo Sant Cugat del Vallès, Barcelona, Spain.,Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC Barcelona), Catalonia, Spain
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Honeyman C, Fries CA. Vascularised Composite Allotransplantation – Basic Science and Clinical Applications. ACTA ACUST UNITED AC 2019. [DOI: 10.29337/ijops.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Is Lower Extremity Transplantation a Superior Alternative to Prostheses? No—At Least Not Yet. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0217-6] [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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12
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Kulahci Y, Karagoz H, Zor F. Experimental Models of Penile and Lower Limb Transplantation: Are They Really Translational? CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0216-7] [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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13
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Thuong M, Petruzzo P, Landin L, Mahillo B, Kay S, Testelin S, Jablecki J, Laouabdia-Sellami K, Lopez-Fraga M, Dominguez-Gil B. Vascularized composite allotransplantation - a Council of Europe position paper. Transpl Int 2018; 32:233-240. [DOI: 10.1111/tri.13370] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/19/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Marie Thuong
- Intensive Care Unit; Hospital René Dubos; Cergy Pontoise France
| | - Palmina Petruzzo
- Department of Vascular Surgery; Hôpital Edouard Herriot; Lyon France
| | - Luis Landin
- Plastic & Reconstructive Surgery; Hospital Universitario La Paz; Madrid Spain
| | | | - Simon Kay
- Leeds Teaching Hospitals NHS Trust; Leeds UK
| | - Sylvie Testelin
- Department of Maxillofacial Surgery; Centre Hospitalier Universitaire Amiens-Picardie; Amiens France
| | | | | | - Marta Lopez-Fraga
- European Committee on Organ Transplantation (CD-P-TO); Council of Europe; Strasbourg France
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Kollar B, Tasigiorgos S, Dorante MI, Carty MJ, Talbot SG, Pomahac B. Innovations in reconstructive microsurgery: Reconstructive transplantation. J Surg Oncol 2018; 118:800-806. [PMID: 30098294 DOI: 10.1002/jso.25147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 12/17/2022]
Abstract
In the past 20 years, reconstructive transplantation (RT) has emerged as a viable reconstructive option for carefully selected patients. More than 100 upper extremity and 40 face transplants have been performed worldwide to date. Concomitantly, the portfolio of reconstructive transplantation has been extended by additional procedures such as lower extremities, abdominal wall, neck, uterus, genitourinary, and pediatric transplants. In the present review article, we aim to summarize the current state of knowledge about this exciting field.
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Affiliation(s)
- Branislav Kollar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sotirios Tasigiorgos
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Miguel I Dorante
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew J Carty
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon G Talbot
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Iglesias M, Ramírez-Berumen M, Butrón P, Alberú-Gómez J, Salazar-Hernández F, Macias-Gallardo J, Leal-Villalpando RP, Zamudio-Bautista J, Acosta V, Jauregui L, Hernández-Campos A, Espinosa-Cruz V, Vázquez-Lamadrid J, González-Sánchez J, Cuellar-Rodriguez J, Sierra-Madero JG, Gaytan-Cervantes R, Contreras-Barbosa S, Navarro-Lara A, Guzman-Gonzalez J, Domínguez-Cherit J, Vilatoba M, Toussaint-Caire S, Vega-Boada F, Gómez-Pérez FJ, Mayorquin-Ruiz M. Functional Outcomes 18 Months After Total and Midarm Transplantation: A Case Report. Transplant Proc 2018; 50:950-958. [PMID: 29555246 DOI: 10.1016/j.transproceed.2017.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/22/2017] [Accepted: 12/12/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND The function reported after arm transplantation is deemed beneficial relative to the marked disability that upper arm amputation causes. OBJECTIVE We report a 51-year-old man with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 75.83 who underwent bilateral arm transplantation in October 2015. PROCEDURE The right arm was transplanted at the glenohumeral joint level, including transplantation of the humeral head, joint capsule, and rotator cuff ligaments and tendons. Additionally, neurorrhaphies were performed at the origin of the terminal branches of the brachial plexus, including the axillary and musculocutaneous nerves. Therefore, this was considered a total arm transplantation. The left arm was transplanted at the transhumeral level, with complete transplantation of the biceps and triceps brachii, and terminolateral neurorrhaphy of the donor musculocutaneous nerve to the receptor radial nerve. A maintenance triple immunosuppression scheme was administered, with tacrolimus levels kept at 10 ng/mL. RESULTS At 18 months post-transplantation, the intrinsic musculature in the left hand showed electrical registry, DASH score was 67.5, Carroll test score was 28 in both extremities, Hand Transplant Score System was 67.5 in the right extremity and 77.5 in the left extremity, and Short Form-36 score was 96.1. The patient was healthy, with restored body integrity. He could lift medium-sized weightless objects, eat and go to the bathroom by himself, drink liquids with bimanual grasp, swim, dress almost independently, and drive. CONCLUSION The functional evolution of the patient was similar to previously reported transplanted arms, even though the right arm transplant involved the glenohumeral joint and axillary and musculocutaneous nerve repair.
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Affiliation(s)
- M Iglesias
- Plastic Surgery Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
| | - M Ramírez-Berumen
- Plastic Surgery Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - P Butrón
- Plastic Surgery Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - J Alberú-Gómez
- Transplant Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - F Salazar-Hernández
- Plastic Surgery Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - J Macias-Gallardo
- Laboratory of Clinical Neurophysiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - R P Leal-Villalpando
- Anesthesiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - J Zamudio-Bautista
- Anesthesiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - V Acosta
- Anesthesiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - L Jauregui
- Anesthesiology Department, Hospital Gea Gonzalez, Secretaria de Salud, Ciudad de México, México
| | - A Hernández-Campos
- Plastic Surgery Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - V Espinosa-Cruz
- Radiology and Imaging Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - J Vázquez-Lamadrid
- Radiology and Imaging Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - J González-Sánchez
- Psychiatry Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - J Cuellar-Rodriguez
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - J G Sierra-Madero
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - R Gaytan-Cervantes
- Rehabilitation Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - S Contreras-Barbosa
- Rehabilitation Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - A Navarro-Lara
- Rehabilitation Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | | | - J Domínguez-Cherit
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición, México City, México
| | - M Vilatoba
- Transplant Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - S Toussaint-Caire
- Dermatology Department, Hospital Gea Gonzalez, Secretaria de Salud, Ciudad de México, México
| | - F Vega-Boada
- Neurology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - F J Gómez-Pérez
- Endocrinology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - M Mayorquin-Ruiz
- Ocular Ultrasound Service, Asociación para Evitar la Ceguera en México, IAP, Ciudad de México, México
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Planinsic RM, Raval JS, Gorantla VS. Anesthesia and Perioperative Care in Reconstructive Transplantation. Anesthesiol Clin 2017; 35:523-538. [PMID: 28784224 DOI: 10.1016/j.anclin.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reconstructive transplantation of vascularized composite allografts (VCAs), such as upper extremity, craniofacial, abdominal, lower extremity, or genitourinary transplants, has emerged as a cutting-edge specialty, with more than 50 programs in the United States and 30 programs across the world performing these procedures. Most VCAs involve complicated technical planning and preparation, protracted surgery, and complex immunosuppressive or immunomodulatory protocols, each associated with unique anesthesiology challenges. This article outlines key procedural, patient, and protocol-related aspects of VCA relevant to anesthesiology management with the goal of ensuring patient safety and optimizing surgical, immunologic, and functional outcomes.
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Affiliation(s)
- Raymond M Planinsic
- Department of Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite C-200, Pittsburgh, PA 15213, USA.
| | - Jay S Raval
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Transfusion Medicine Service, Hematopoietic Progenitor Cell Laboratory, University of North Carolina at Chapel Hill, 101 Manning Drive, Suite C3162, Chapel Hill, NC 27514, USA
| | - Vijay S Gorantla
- Departments of Surgery, Ophthalmology and Bioengineering, US Air Force, Wake Forest Institute for Regenerative Medicine, Wake Forest Baptist Medical Center, Richard H. Dean Biomedical Building, 391 Technology Way, Winston Salem, NC 27101, USA.
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Acellular Hypothermic Extracorporeal Perfusion Extends Allowable Ischemia Time in a Porcine Whole Limb Replantation Model. Plast Reconstr Surg 2017; 139:922e-932e. [DOI: 10.1097/prs.0000000000003208] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Vascularized Composite Allotransplantation—An Emerging Concept for Burn Reconstruction. J Burn Care Res 2017; 38:371-378. [DOI: 10.1097/bcr.0000000000000532] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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20
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Facial transplantation: worth the risks? A look at evolution of indications over the last decade. Curr Opin Organ Transplant 2016; 20:615-20. [PMID: 26536422 DOI: 10.1097/mot.0000000000000253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The first face transplant was performed 10 years ago by Dubernard and his team in France. Since then, surgeons have continued to push the frontiers of vascularized composite allotransplantation and broaden the indications for face transplantation. In this review, we summarize some of the recent successes and failures in facial transplantation from the point of view of indications. RECENT FINDINGS Recent literature includes case reports on face transplants in sensitized patient, with simultaneous bilateral upper extremity transplants, positive HIV status, and postmalignancy. Additionally, we summarize some of the outcomes of face transplants, including chronic rejection and latent viral infections. SUMMARY Facial injuries vary widely, thus candidacy for face transplant should be assessed based on current guidelines, and a case-by-case basis. Although sensitization to donor-specific antigens should not be an absolute contraindication for facial allotransplantation, along with other comorbidities such as positive HIV status, history of malignancy should be evaluated cautiously. Additionally, multiple case studies advice against simultaneous transplantation of multiple vascularized composite allotransplantations. Other considerations include psychological health, social support, and availability for long-term follow-up. Ultimately, face transplant is not simply a surgery; it is a lifelong commitment between a patient and his/her medical team.
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