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Süzen E, Şavklıyıldız A, Özkan Ö, Çolak ÖH, Apaydın Doğan E, Özkan Ö, Şimşek B, Uluşar ÜD, Carlak HF, Polat Ö, Uysal H. Delta waves as a sign of cortical plasticity after full-face transplantation. Sci Rep 2024; 14:16454. [PMID: 39014053 PMCID: PMC11252439 DOI: 10.1038/s41598-024-67469-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/11/2024] [Indexed: 07/18/2024] Open
Abstract
This study focused on detecting the reflections of healing and change in cortex activation in full-face transplantation and lesions patients on EEG activity. Face transplant patients have facial lesions before transplantation and, to identify pre-face transplant patients' brain activity in the absence of pre-transplant recordings, we used data obtained from pre-transplant facial lesion patients. Ten healthy, four facial lesion and three full-face transplant patients participated in this study. EEG data recorded for four different sensory stimuli (brush from the right face, right hand, left face, and left-hand regions) were analyzed using wavelet packet transform method. EEG waves were analyzed for standard bands. Our findings indicate significant change in the 2-4 Hz frequency range which may be a result of ongoing or previous cortical reorganization for face lesion and transplant patients. Alterations of the delta wave seen in patients with facial lesion and face transplant can also be explained by the intense central plasticity. Our findings show that the delta band differences might be used as a marker in the evaluation of post-transplant cortical plasticity in the future.
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Affiliation(s)
- Esra Süzen
- Faculty of Engineering, Department of Electrical and Electronics Engineering, Akdeniz University, Pınarbasi Blvd., Antalya, Turkey
| | - Ayhan Şavklıyıldız
- Faculty of Engineering, Department of Electrical and Electronics Engineering, Akdeniz University, Pınarbasi Blvd., Antalya, Turkey
| | - Ömer Özkan
- Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Akdeniz University, Antalya, Turkey
| | - Ömer Halil Çolak
- Faculty of Engineering, Department of Electrical and Electronics Engineering, Akdeniz University, Pınarbasi Blvd., Antalya, Turkey.
| | - Ebru Apaydın Doğan
- Faculty of Medicine, Department of Neurology, Akdeniz University, Antalya, Turkey
| | - Özlenen Özkan
- Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Akdeniz University, Antalya, Turkey
| | - Buket Şimşek
- Faculty of Engineering, Department of Electrical and Electronics Engineering, Akdeniz University, Pınarbasi Blvd., Antalya, Turkey
| | - Ümit Deniz Uluşar
- Faculty of Engineering, Department of Computer Engineering, Akdeniz University, Antalya, Turkey
| | - Hamza Feza Carlak
- Faculty of Engineering, Department of Electrical and Electronics Engineering, Akdeniz University, Pınarbasi Blvd., Antalya, Turkey
| | - Övünç Polat
- Faculty of Engineering, Department of Electrical and Electronics Engineering, Akdeniz University, Pınarbasi Blvd., Antalya, Turkey
| | - Hilmi Uysal
- Faculty of Medicine, Department of Neurology, Akdeniz University, Antalya, Turkey
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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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Esmaeili J, Barati A, Charelli LE. Discussing the final size and shape of the reconstructed tissues in tissue engineering. J Artif Organs 2022:10.1007/s10047-022-01360-1. [PMID: 36125581 DOI: 10.1007/s10047-022-01360-1] [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: 04/05/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
Tissue engineering (TE) has made a revolution in repairing, replacing, or regenerating tissues or organs, but it has still a long way ahead. The mechanical properties along with suitable physicochemical and biological characteristics are the initial criteria for scaffolds in TE that should be fulfilled. This research will provide another point of view toward TE challenges concerning the morphological and geometrical aspects of the reconstructed tissue and which parameters may affect it. Based on our survey, there is a high possibility that the final reconstructed tissue may be different in size and shape compared to the original design scaffold. Thereby, the 3D-printed scaffold might not guarantee an accurate tissue reconstruction. The main justification for this is the unpredicted behavior of cells, specifically in the outer layer of the scaffold. It can also be a concern when the scaffold is implanted while cell migration cannot be controlled through the in vivo signaling pathways, which might cause cancer challenges. To sum up, it is concluded that more studies are necessary to focus on the size and geometry of the final reconstructed tissue.
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Affiliation(s)
- Javad Esmaeili
- Department of Chemical Engineering, Faculty of Engineering, Arak University, Arak, 38156-88349, Iran.,Tissue Engineering Department, TISSUEHUB Co., Tehran, Iran
| | - Aboulfazl Barati
- Department of Chemical Engineering, Faculty of Engineering, Arak University, Arak, 38156-88349, Iran.
| | - Letícia Emiliano Charelli
- Nanotechnology Engineering Program, Alberto Luiz Coimbra Institute for Graduate Studies and Research in Engineering, COPPE, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Myhre A, Råbu M, Feragen KJB. The need to belong: Subjective experiences of living with craniofacial conditions and undergoing appearance-altering surgery. Body Image 2021; 38:334-345. [PMID: 34087543 DOI: 10.1016/j.bodyim.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/08/2021] [Accepted: 05/20/2021] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to better understand how individuals with craniofacial conditions experience living with visible differences and make sense of appearance-altering surgery. We conducted semi-structured qualitative interviews with 11 adults with Goldenhar or Crouzon syndrome. Interviews were analysed using a hermeneutic-phenomenological approach to thematic analysis. Our analysis revealed the following overarching theme, To see myself as other people see me, which encompassed three main themes: a) Striving to fit in, b) Altering the way I look and c) Support from family and friends. The participants' sense of their own appearance seemed to be connected to how they perceived others to evaluate their appearance. All had experienced negative reactions from others. They experienced themselves as different and had a desire to belong. All participants had undergone appearance-altering surgery, hoping that by changing appearance, they would reduce negative reactions and feel more connected to and accepted by other people. The process of undergoing appearance-changing surgery was experienced as challenging, and participants wished for a dialogue with surgeons which included psychological and emotional aspects of changing appearance. A better understanding of how to strengthen positive identity processes and feelings of belongingness should be a key focus of future research.
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Affiliation(s)
- Anita Myhre
- Centre for Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.
| | - Marit Råbu
- University of Oslo, Department of Psychology, Postboks 1094 Blindern, 0317, Oslo, Norway.
| | - Kristin J B Feragen
- Centre for Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.
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Johannesson L, Wall A, Tzakis A, Quintini C, Richards EG, O'Neill K, Porrett PM, Testa G. Life underneath the VCA umbrella: Perspectives from the US Uterus Transplant Consortium. Am J Transplant 2021; 21:1699-1704. [PMID: 33314584 DOI: 10.1111/ajt.16445] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 01/25/2023]
Abstract
The parallel emergence of uterus transplantation (UTx) and other transplantation innovations including face and hand transplantation led to the categorization of the uterus as a vascular composite allograft (VCA). With >60 transplants and >20 births worldwide, UTx is transitioning rapidly from a research endeavor to an effective treatment option for women with uterine factor infertility. While it originally made sense to group the innovations under one umbrella, it is time to revisit the designation of UTx as a VCA. We describe how UTx needs unique policy, procedural codes, insurance contracts, and educational initiatives. We contend that separating UTx from VCAs may become necessary in the future to avoid hindering the growth and regulation of this field.
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Affiliation(s)
- Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Anji Wall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Andreas Tzakis
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Elliott G Richards
- Fertility Preservation Program, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kathleen O'Neill
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paige M Porrett
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
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6
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Three-dimensional scanners for soft-tissue facial assessment in clinical practice. J Plast Reconstr Aesthet Surg 2021; 74:605-614. [DOI: 10.1016/j.bjps.2020.08.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023]
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Schneider SA, Gateno J, Coppelson KB, English JD, Xia JJ. Validity of Medical Insurance Guidelines for Orthognathic Surgery. J Oral Maxillofac Surg 2021; 79:672-684. [PMID: 33338420 PMCID: PMC7925386 DOI: 10.1016/j.joms.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the validity of the medical insurance guidelines for orthognathic surgery used by the major American medical insurance companies. MATERIALS AND METHODS This study assessed the validity of the medical insurance guidelines for orthognathic surgery used by Aetna, Anthem Blue Cross Blue Shield (BCBS), Cigna, Humana, and UnitedHealthcare (UHC). To evaluate the validity, we calculated the approval and denial rates of the 5 guidelines when we used them to assess the medical necessity for a control group of carefully selected patients. Patients were included in the control group if they met the criteria of a "prudent provider," crafted for this study. All rejected cases were analyzed to determine the root cause of the denials. The validity of the guidelines was also ascertained by determining their completeness and correctness. RESULTS The current study proves that no insurance guideline is in agreement with the criteria of a "prudent provider." When applied to carefully chosen patients, the requirements of BCBS, Aetna, Humana, and Cigna produce modest rejection rates of 6 to 12%. UHC is an outlier. Its guideline rejects 86% of patients, a rate about 7 times higher than its peers. Insurance guidelines disqualified patients for 3 different reasons: 1) no significant jaw deformity, 2) no demonstrable health impairment, and 3) the etiology of the condition is not a covered benefit. Additional evaluations demonstrate that the private insurance guidelines are incomplete, and at times, incorrect. CONCLUSIONS This study shows that the medical insurance guidelines for orthognathic surgery used by the major American medical insurance plans need revision. The most consequential flaw was considering etiology in judging medical necessity. Fortunately, only one company adopted this policy. Moreover, all guidelines have omissions and errors in the way jaw deformity is determined and how health impairment is determined.
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Affiliation(s)
- Sydney A Schneider
- Resident and Graduate Student, Department of Orthodontics, University of Texas Houston Health Science Center School of Dentistry, Houston, TX
| | - Jaime Gateno
- Chairman, Oral and Maxillofacial Surgery Department, Houston Methodist Hospital, Professor of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Houston, TX; and Professor of Clinical Surgery (Oral and Maxillofacial Surgery), Weill-Cornell Medical College, New York, NY
| | - Kevin B Coppelson
- Former Advanced Oral and Maxillofacial Surgery Fellow, Houston Methodist Hospital, Houston, TX
| | - Jeryl D English
- Professor and Chairman, Department of Orthodontics, University of Texas Houston Health Science Center School of Dentistry, Houston, TX
| | - James J Xia
- Director of Surgical Planning Laboratory, Oral and Maxillofacial Surgery Department, Houston Methodist Hospital, Houston, TX; Professor of Oral and Maxillofacial Surgery, Houston Methodist Academic Institute, Houston, TX; and Professor of Surgery (Oral and Maxillofacial Surgery), Weill-Cornell Medical College, New York, NY.
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Corniani G, Saal HP. Tactile innervation densities across the whole body. J Neurophysiol 2020; 124:1229-1240. [DOI: 10.1152/jn.00313.2020] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The skin is our largest sensory organ and innervated by afferent fibers carrying tactile information to the spinal cord and onto the brain. The density with which different classes of tactile afferents innervate the skin is not constant but varies considerably across different body regions. However, precise estimates of innervation density are only available for some body parts, such as the hands, and estimates of the total number of tactile afferent fibers are inconsistent and incomplete. Here we reconcile different estimates and provide plausible ranges and best estimates for the number of different tactile fiber types innervating different regions of the skin, using evidence from dorsal root fiber counts, microneurography, histology, and psychophysics. We estimate that the skin across the whole body of young adults is innervated by ∼230,000 tactile afferent fibers (plausible range: 200,000–270,000), with a subsequent decrement of 5–8% every decade due to aging. Fifteen percent of fibers innervate the palmar skin of both hands and 19% the region surrounding the face and lips. Slowly and fast-adapting fibers are split roughly evenly, but this breakdown varies with skin region. Innervation density correlates well with psychophysical spatial acuity across different body regions, and, additionally, on hairy skin, with hair follicle density. Innervation density is also weakly correlated with the size of the cortical somatotopic representation but cannot fully account for the magnification of the hands and the face.
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Affiliation(s)
- Giulia Corniani
- Active Touch Laboratory, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
- Sheffield Robotics, University of Sheffield, Sheffield, United Kingdom
| | - Hannes P. Saal
- Active Touch Laboratory, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
- Sheffield Robotics, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
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10
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Abstract
Face transplantation is a complex vascular composite allotransplantation (VCA) surgery. It involves multiple types of tissue, such as bone, muscles, blood vessels, nerves to be transferred from the donor to the recipient as one unit. VCAs were added to the definition of organs covered by the Organ Procurement and Transplantation Network Final Rule and National Organ Transplant Act. Prior to harvest of the face from the donor, a tracheostomy is usually performed. The osteotomies and dissection of the midface bony skeleton may involve severe hemorrhagic blood loss often requiring transfusion of blood products. A silicon face mask created from the facial impression is used to reconstruct the face and preserve the donor’s dignity. The recipient airway management most commonly used is primary intubation of an existing tracheostoma with a flexometallic endotracheal tube. The recipient surgery usually averages to 19-20 h. Since the face is a very vascular organ, there is usually massive bleeding, both in the dissection phase as well as in the reperfusion phase. Prior to reperfusion, often, after one sided anastomosis of the graft, the contralateral side is allowed to bleed to get rid of the preservation solution and other additives. Intraoperative product replacement should be guided by laboratory values and point of care testing for coagulation and hemostasis. In face transplantation, bolus doses of pressors or pressor infusions have been used intraoperatively in several patients to manage hypotension. This article reviews the anesthetic considerations for management for face transplantation, and some of the perioperative challenges faced.
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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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Shaul RZ, Borschel GH, Flynn J, Hanson MD, Wright L, Zuker RM. Ethical Issues in Pediatric Vascularized Composite Allotransplantation. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-29185-7_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Busnardo FDF, Coltro PS, Olivan MV, Barreiro GC, Baptista RR, Ferreira MC, Gemperli R. Face transplantation in rats. Reproducibility of the experimental model in Brazil. Acta Cir Bras 2014; 29:532-7. [DOI: 10.1590/s0102-86502014000800009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/11/2014] [Indexed: 11/22/2022] Open
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Abstract
Vascularized composite allotransplantation is a continuously evolving area of modern transplant medicine. Recently, vascularized composite allografts (VCAs) have been formally classified as 'organs'. In this review, key aspects of VCA procurement are discussed, with a special focus on interaction with the procurement of classical solid organs. In addition, options for a matching and allocation system that ensures VCA donor organs are allocated to the best-suited recipients are looked at. Finally, the different steps needed to promote VCA transplantation in society in general and in the medical community in particular are highlighted.
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Affiliation(s)
- Axel Rahmel
- Deutsche Stiftung Organtransplantation, Deutschherrnufer 52, Frankfurt am Main, 60594 Frankfurt, Germany
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Flynn J, Zlotnik RS, Hanson MD, Borschel GH, Zuker R. Article Commentary: Pediatric facial transplantation: Ethical considerations. Plast Surg (Oakv) 2014. [DOI: 10.1177/229255031402200212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jennifer Flynn
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador
| | - Randi Shaul Zlotnik
- Department of Bioethics, The Hospital for Sick Children
- Department of Paediatrics; University of Toronto, Toronto, Ontario
| | - Mark D Hanson
- Department of Psychiatry, Faculty of Medicine, University of Toronto
| | - Gregory H Borschel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, Ontario
| | - Ronald Zuker
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, Ontario
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Muramatsu K, Taguchi T. Human hand transplants and challenges for adaptation in Japan. Microsurgery 2013; 34:335-6. [PMID: 24352811 DOI: 10.1002/micr.22211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/16/2013] [Accepted: 11/19/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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Coffman KL, Siemionow MZ. Face transplantation: psychological outcomes at three-year follow-up. PSYCHOSOMATICS 2013; 54:372-8. [PMID: 23352049 DOI: 10.1016/j.psym.2012.10.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 10/12/2012] [Accepted: 10/22/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The advent of face transplantation has raised both ethical and psychological issues. Mortality of 18 existing face transplant recipients is 11.1% (2/18) through 2011. OBJECTIVE Psychological outcomes are as important in face transplantation as is restoring the face physically. Little quantitative information has been published this area. METHODS Data was systematically collected over 3 years with a face transplant recipient, including appearance self-rating, body image, mood changes, pain rating, perception of teasing, quality of life, self-esteem, and social reintegration. We identified a significant gap in rating instruments for use in the field, so we developed the Perception of Teasing-FACES, Facial Anxiety Scale-State, and the Cleveland Clinic FACES score, analogous to the model for end-stage liver disease (MELD) score for prioritizing patients for a face transplant registry. RESULTS Appearance self-rating rose from 3/10 prior to transplantation to 7/10 now. Anxiety about body image and the Facial Anxiety score were halved by the end of the third year. Beck Depression Inventory fell from 16 (prior to transplant) to 8. Chronic daily pain was 6-7/10 prior to transplant and 0/10 by day 50. Perception of Teasing-FACES scores fell from 25 to 9 by the end of year 3. Quality of life improved on the Social Environment Domain of the psychological adjustment to illness scale-self-rated (PAIS-SR), where the score dropped from 15 to 1 by the end of year 3, indicating marked improvement in social reintegration. CONCLUSIONS Standardized data collection may help quantify psychological outcomes with facial transplantation to determine whether the risks of immunosuppression over time are offset by improved quality of life for recipients.
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Affiliation(s)
- Kathy L Coffman
- Department of Psychiatry, Cleveland Clinic, Cleveland, OH 44195, USA.
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Iliac Crest Flap for Mandibular Reconstruction After Advanced Stage Mandibular Ameloblastoma Resection. Ann Plast Surg 2012; 69:529-34. [DOI: 10.1097/sap.0b013e31821d06f3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Skin Area Quantification in Preparation for Concomitant Upper Extremity and Face Transplantation: A Cadaver Study and Literature Review. Transplantation 2011; 91:1050-6. [DOI: 10.1097/tp.0b013e318212c815] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Institutional review board-based recommendations for medical institutions pursuing protocol approval for facial transplantation. Plast Reconstr Surg 2010; 126:1232-1239. [PMID: 20885245 DOI: 10.1097/prs.0b013e3181ee482d] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preliminary outcomes from the previous nine face transplants performed since 2005 have been encouraging and have therefore led to a rise in the number of medical centers interested in establishing face transplant programs worldwide. However, until now, very little literature has been published providing surgeons the necessary insight on how to (1) prepare a protocol for institutional review board approval and (2) establish a face transplant program. METHODS The authors' face transplant team's experience with the institutional review board at the Cleveland Clinic, beginning in 2002, was critically reviewed in a detailed, retrospective manner. The purpose was to identify and define certain criteria necessary for both the institutional review board approval process and face transplant program establishment. RESULTS In 2002, unprecedented efforts from within the authors' plastic surgery department led to the world's first institutional review board approval for face transplantation, in 2004. As a result, 4 years later, the authors' face transplant team performed the nation's first successful near-total face and maxilla transplant. CONCLUSIONS Every surgical department hoping to establish a face transplant program must realize that this endeavor requires both tremendous financial and long-term commitments by its medical institution. These transplants should be performed only within university-based medical centers capable of orchestrating a specialized, talented, multidisciplinary team. More importantly, facial composite tissue allotransplantation possesses an unmatched level of complexity and therefore requires most centers to prepare a carefully detailed protocol using these institutional review board-based guidelines.
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Hinojosa Pérez R, Porras López M, Escoresca-Ortega A, Herruzo Avilés A, León A, Noval J, Gómez-Cía T, Sicilia D, González Padilla J. Severe Rhabdomyolysis After Allogeneic Transplantation of Facial Structures: A Case Report. Transplant Proc 2010; 42:3081-2. [DOI: 10.1016/j.transproceed.2010.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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The world's experience with facial transplantation: what have we learned thus far? Ann Plast Surg 2010; 63:572-8. [PMID: 19806039 DOI: 10.1097/sap.0b013e3181ba5245] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The objective of this review article is to summarize the published details and media citations for all seven face transplants performed to date to point out deficiencies in those reports so as to provide the basis for examining where the field of face transplantation stands, and to act as a stimulus to enhance the quality of future reports and functional outcomes. Overall long-term function of facial alloflaps has been reported satisfactorily in all seven cases. Sensory recovery ranges between 3 and 6 months, and acceptable motor recovery ranges between 9 and 12 months. The risks and benefits of facial composite tissue allotransplantation, which involves mandatory lifelong immunosuppression analogous to kidney transplants, should be deliberated by each institution's multidisciplinary face transplant team. Face transplantation has been shown thus far to be a viable option in some patients suffering severe facial deficits which are not amenable to modern-day reconstructive technique.
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Psychological outcomes with face transplantation: overview and case report. Curr Opin Organ Transplant 2010; 15:236-40. [PMID: 20308897 DOI: 10.1097/mot.0b013e328337267d] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide guidance in a burgeoning new field of facial composite tissue transplantation. This review will contrast face transplant with solid organ transplantation, provide information to guide selection of face transplant candidates, and share information on psychological outcomes. RECENT FINDINGS Previously published face transplant reports have not investigated body image, mood changes, perception of teasing, quality of life, self-esteem, or social reintegration quantitatively. Face transplantation appears to decrease depression and verbal abuse, and improve quality of life and social reintegration, though may not alter anxiety or self-esteem. The Psychosocial Adjustment for Illness Scale-Self-Report scale may have advantages over the SF-36 and World Health Organization Quality of Life (WHOQOL)-BREF rating scales for measuring psychological distress and social reintegration. SUMMARY Face transplantation is currently a technique of last resort after traditional reconstructive techniques have failed, not for cosmesis alone. Mortality among eight existing face transplant patients is 25%, two of eight. Some consider blindness as an absolute contraindication; however, those who are legally blind but retain some vision may be appropriate candidates. Physical goals of transplantation include regaining movement of underlying structures and restoring the appearance of a normal face. However, psychological outcomes and quality of life are also important to the success of face transplantation and ultimately will determine the value of the procedure.
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Siemionow M, Gordon CR. Overview of guidelines for establishing a face transplant program: a work in progress. Am J Transplant 2010; 10:1290-6. [PMID: 20353470 DOI: 10.1111/j.1600-6143.2010.03096.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since 2005, nine face transplants have been performed in four countries: France, the United States (US), China and Spain. These encouraging short-term outcomes, with the longest survivor approaching 5 years, have led to an increased interest in establishing face transplant programs worldwide. Therefore, the purpose of this article is to facilitate the dissemination of relevant details as per our experience in an effort to assist those medical centers interested in establishing a face transplant program. In this article, we address the logistical challenges involved with face transplantation; including essential program requirements, protocol details, face transplant team assembly, project funding, the organ procurement organization and the coroner. It must be emphasized that face transplantation is still experimental and its therapeutic value remains to be validated. All surgical teams pursuing this endeavor must dedicate an attention to detail and should accept a responsibility to publish their outcomes in a transparent manner in order to contribute to the international field. However, due to its inherent complexity, facial transplantation should only be performed by university-affiliated medical institutions capable of orchestrating a specialized multidisciplinary team with a long-term commitment to its success.
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Affiliation(s)
- M Siemionow
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Current world literature. Curr Opin Organ Transplant 2010; 15:254-61. [PMID: 20351662 DOI: 10.1097/mot.0b013e328337a8db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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BÅogowski W. Facial transplantation as an option in reconstructive surgery: no mountains too high? ANZ J Surg 2009; 79:892-7. [DOI: 10.1111/j.1445-2197.2009.05140.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Knobloch K, Rennekampff HO, Meyer-Marcotty M, Gohritz A, Vogt PM. [Organ transplantation, composite tissue allotransplantation, and plastic surgery]. Chirurg 2009; 80:519-26. [PMID: 19214462 DOI: 10.1007/s00104-008-1668-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Transplantations play an increasing role for plastic reconstructive surgeons. The increasing number of solid organ transplantations and the improved long-term survival rates lead to increased numbers of these patients also undergoing plastic and reconstructive procedures. Free flap transfer in solid organ transplant patients is feasible with no higher risk to both transplant function and postoperative complications than for nontransplant patients, even during immune suppression. Composite tissue allotransplantation (CTA) is an evolving field in plastic reconstructive surgery with hands, arms, partial faces, abdominal walls, and knee joints being transferred in clinical settings. However only an interdisciplinary approach using all available resources in highly selected patients after exhausting all other plastic reconstructive procedures is able to achieve reasonable results. The potential complications of long-term immune suppression and patient compliance have to be balanced with the expected and achieved functional result of CTA, whose procedures must be discussed as a potential tissue or organ transplantation, given the legal and logistic implications. The interdisciplinary cooperation of transplant surgeons, microsurgeons, psychologists, and ergo- and physiotherapists is mandatory to achieve successful CTA results.
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Affiliation(s)
- K Knobloch
- Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Deutschland.
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Courage and Character, Leaders and Legends: An Interview with Maria Siemionow, MD, PhD, DSc. Prog Transplant 2009; 19:203-4. [DOI: 10.1177/152692480901900301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Courage and character, leaders and legends: an interview with Maria Siemionow, MD, PhD, DSc. Prog Transplant 2009. [DOI: 10.7182/prtr.19.3.q4246112j2600481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Facial transplantation in a new era: what are the ethical implications? Curr Opin Otolaryngol Head Neck Surg 2009; 17:274-8. [DOI: 10.1097/moo.0b013e32832cba57] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Current Opinion in Otolaryngology & Head and Neck Surgery. Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:326-31. [PMID: 19602933 DOI: 10.1097/moo.0b013e32832fa68b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Facial Transplantation: The Next Frontier in Head and Neck Reconstruction. Facial Plast Surg Clin North Am 2009; 17:271-7. [DOI: 10.1016/j.fsc.2009.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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