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Aviña AE, De Paz D, Huang SC, Chen KH, Chang YC, Lee CM, Lin CH, Wei FC, Wang AYL. IL-10 modified mRNA monotherapy prolongs survival after composite facial allografting through the induction of mixed chimerism. MOLECULAR THERAPY. NUCLEIC ACIDS 2023; 31:610-627. [PMID: 36910717 PMCID: PMC9996371 DOI: 10.1016/j.omtn.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
Vascularized composite allotransplantation has great potential in face transplantation by supporting functional restoration following tissue grafting. However, the need for lifelong administration of immunosuppressive drugs still limits its wide use. Modified mRNA (modRNA) technology provides an efficient and safe method to directly produce protein in vivo. Nevertheless, the use of IL-10 modRNA-based protein replacement, which exhibits anti-inflammatory properties, has not been shown to prolong composite facial allograft survival. In this study, IL-10 modRNA was demonstrated to produce functional IL-10 protein in vitro, which inhibited pro-inflammatory cytokines and in vivo formation of an anti-inflammatory environments. We found that without any immunosuppression, C57BL/6J mice with fully major histocompatibility complex (MHC)-mismatched facial allografts and local injection of IL-10 modRNA had a significantly prolonged survival rate. Decreased lymphocyte infiltration and pro-inflammatory T helper 1 subsets and increased anti-inflammatory regulatory T cells (Tregs) were seen in IL-10 modRNA-treated mice. Moreover, IL-10 modRNA induced multilineage chimerism, especially the development of donor Treg chimerism, which protected allografts from destruction because of recipient alloimmunity. These results support the use of monotherapy based on immunomodulatory IL-10 cytokines encoded by modRNA, which inhibit acute rejection and prolong allograft survival through the induction of donor Treg chimerism.
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Affiliation(s)
- Ana Elena Aviña
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.,Clinical Fellow, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung University and Medical College, Taoyuan 333, Taiwan
| | - Dante De Paz
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.,Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.,Department of Head and Neck Surgery, National Police Hospital, Lima 15072, Peru
| | - Shu-Chun Huang
- Department of Physical Medicine and Rehabilitation, New Taipei Municipal Tucheng Hospital, Chang Gung Memorial Hospital, New Taipei 236, Taiwan.,Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuan-Hung Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yun-Ching Chang
- Department of Health Industry Technology Management, Chung Shan Medical University, Taichung 402, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chin-Ming Lee
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chia-Hsien Lin
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Fu-Chan Wei
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.,Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Aline Yen Ling Wang
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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De Paz D, Aviña AE, Cardona E, Lee CM, Lin CH, Lin CH, Wei FC, Wang AYL. The Mandible Ameliorates Facial Allograft Rejection and Is Associated with the Development of Regulatory T Cells and Mixed Chimerism. Int J Mol Sci 2021; 22:11104. [PMID: 34681764 PMCID: PMC8537927 DOI: 10.3390/ijms222011104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Vascularized composite allografts contain various tissue components and possess relative antigenicity, eliciting different degrees of alloimmune responses. To investigate the strategies for achieving facial allograft tolerance, we established a mouse hemiface transplant model, including the skin, muscle, mandible, mucosa, and vessels. However, the immunomodulatory effects of the mandible on facial allografts remain unclear. To understand the effects of the mandible on facial allograft survival, we compared the diversities of different facial allograft-elicited alloimmunity between a facial osteomyocutaneous allograft (OMC), including skin, muscle, oral mucosa, and vessels, and especially the mandible, and a myocutaneous allograft (MC) including the skin, muscle, oral mucosa, and vessels, but not the mandible. The different facial allografts of a BALB/c donor were transplanted into a heterotopic neck defect on fully major histocompatibility complex-mismatched C57BL/6 mice. The allogeneic OMC (Allo-OMC) group exhibited significant prolongation of facial allograft survival compared to the allogeneic MC group, both in the presence and absence of FK506 immunosuppressive drugs. With the use of FK506 monotherapy (2 mg/kg) for 21 days, the allo-OMC group, including the mandible, showed prolongation of facial allograft survival of up to 65 days, whereas the myocutaneous allograft, without the mandible, only survived for 34 days. The Allo-OMC group also displayed decreased lymphocyte infiltration into the facial allograft. Both groups showed similar percentages of B cells, T cells, natural killer cells, macrophages, and dendritic cells in the blood, spleen, and lymph nodes. However, a decrease in pro-inflammatory T helper 1 cells and an increase in anti-inflammatory regulatory T cells were observed in the blood and lymph nodes of the Allo-OMC group. Significantly increased percentages of donor immune cells were also observed in three lymphoid organs of the Allo-OMC group, suggesting mixed chimerism induction. These results indicated that the mandible has the potential to induce anti-inflammatory effects and mixed chimerism for prolonging facial allograft survival. The immunomodulatory understanding of the mandible could contribute to reducing the use of immunosuppressive regimens in clinical face allotransplantation including the mandible.
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Affiliation(s)
- Dante De Paz
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (D.D.P.); (A.E.A.); (C.-H.L.); (F.-C.W.)
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-M.L.); (C.-H.L.)
- Department of Head and Neck Surgery, National Police Hospital, Lima 15072, Peru
| | - Ana Elena Aviña
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (D.D.P.); (A.E.A.); (C.-H.L.); (F.-C.W.)
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-M.L.); (C.-H.L.)
| | - Esteban Cardona
- Department of Plastic Surgery, Clínica IPS Universitaria León XIII, University of Antioquia, Medellín 050010, Colombia;
| | - Chin-Ming Lee
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-M.L.); (C.-H.L.)
| | - Chia-Hsien Lin
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-M.L.); (C.-H.L.)
| | - Cheng-Hung Lin
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (D.D.P.); (A.E.A.); (C.-H.L.); (F.-C.W.)
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-M.L.); (C.-H.L.)
| | - Fu-Chan Wei
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (D.D.P.); (A.E.A.); (C.-H.L.); (F.-C.W.)
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-M.L.); (C.-H.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Aline Yen Ling Wang
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (C.-M.L.); (C.-H.L.)
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Wolfe EM, Alfonso AR, Diep GK, Berman ZP, Mills EC, Park JJ, Hoffman AF, Felsenheld JH, Ramly EP, Rodriguez ED. Is Digital Animation Superior to Text Resources for Facial Transplantation Education? A Randomized Controlled Trial. Plast Reconstr Surg 2021; 148:419-426. [PMID: 34181597 DOI: 10.1097/prs.0000000000008166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial transplantation is a complex surgical procedure that requires education of medical professionals, patients, and the general public. The objective of this randomized controlled trial was to compare the educational efficacy of facial transplantation digital animation versus text resources for teaching medical students a complex surgical procedure and its applicable anatomical and surgical principles. METHODS Medical student volunteers were recruited and prospectively randomized to an animation or a text group. Students completed preintervention and postintervention assessments of confidence and knowledge of head and neck anatomy and facial transplantation. Student Evaluations of Educational Quality survey assessed student satisfaction with both tools following study crossover. Knowledge assessment was developed using National Board of Medical Examiners guidelines and content validated by four experts. The Cohen d statistic was used to measure the effect size of each intervention. RESULTS Thirty-six students were assigned randomly to the animation group (n = 19) or the text (n = 17) group. Postintervention analysis demonstrated significantly higher performance scores in the animation group compared to the text group (p = 0.029). The animation group had a larger effect size (Cohen d = 1.96 versus 1.27). Only students in the animation group reported significantly improved confidence in head and neck anatomy after the intervention (p = 0.002). Both groups demonstrated significantly increased postintervention confidence in knowledge of facial transplantation (p < 0.001). Satisfaction scores revealed that students significantly favored the animation resource (p < 0.001). CONCLUSIONS Animation can be an effective tool for facial transplantation education and results in improved student knowledge, confidence, and satisfaction compared to text resources. Facial transplantation can also be used as an educational framework for teaching medical students anatomical and surgical principles.
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Affiliation(s)
- Erin M Wolfe
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Allyson R Alfonso
- 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
| | - Emily C Mills
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Jenn J Park
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Alexandra F Hoffman
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Julia H Felsenheld
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Elie P Ramly
- 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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4
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Bélanger ME, Borsuk DE, Clairoux A, Fortier LP, Nguyen A, Georgescu M, Richebé P, Tanoubi I, Verdonck O, Gobert Q. Face transplantation: anesthesia and other organizational considerations. Can J Anaesth 2021; 68:868-875. [PMID: 34002361 PMCID: PMC8128356 DOI: 10.1007/s12630-021-01940-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022] Open
Abstract
In 2005, the first facial vascularized composite allotransplant was performed in France. In May 2018, our team at Maisonneuve-Rosemont Hospital, Montreal, Quebec, had the privilege to participate in the first facial transplant in Canada. Interdisciplinary collaboration, coordination, and communication formed the cornerstone of this medical undertaking and, ultimately, its success. This report details the anesthetic and organizational considerations of our experience.
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Affiliation(s)
- Marie-Eve Bélanger
- Department of Anesthesiology and Pain Medicine, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
| | - Daniel E Borsuk
- Department of Surgery, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, Montréal, QC, Canada
| | - Ariane Clairoux
- Department of Anesthesiology and Pain Medicine, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Louis-Philippe Fortier
- Department of Anesthesiology and Pain Medicine, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Anh Nguyen
- Department of Anesthesiology and Pain Medicine, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Mihai Georgescu
- Department of Anesthesiology and Pain Medicine, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Issam Tanoubi
- Department of Anesthesiology and Pain Medicine, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Olivier Verdonck
- Department of Anesthesiology and Pain Medicine, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Quentin Gobert
- Department of Anesthesiology and Pain Medicine, Université de Montréal, CIUSSS de l'Est-de-l'Île-de-Montréal, Maisonneuve-Rosemont Hospital, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
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5
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Ghanem A, Borg TM, Sadigh P, Myers S, Smith D, Holmes S. Craniomaxillofacial trauma management in austere and war zone environments - A role for composite tissue allotransplantation? ANNALS OF BURNS AND FIRE DISASTERS 2019; 32:308-320. [PMID: 32431582 PMCID: PMC7197907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/24/2019] [Indexed: 06/11/2023]
Abstract
Facial composite tissue allotransplantation (CTA) is a powerful reconstructive option in cases of extensive severe facial injury and tissue loss. Despite the risk of allograft rejection and the post-operative need for lifelong immunosuppression, facial CTA can be used to restore the normal structural appearance and function of the face. Areas of socioeconomic deprivation and armed conflict zones have a high preponderance of patients with facial burns and other severe injuries. However, these regions often also suffer from lack of resources, expert surgical care and limited facilities. The purpose of this manuscript is to provide a comprehensive review of key principles relevant to facial CTA and their potential applicability in such austere environments. We present a concise literature review of the surgical and immunological basis of facial CTA aimed at the plastic surgery readership, as well as issues surrounding organ transplantations in low- and middle- income countries. We then consider the particular challenges posed by austere settings and countries of active armed conflict and discuss how these may impact the suitability of facial CTA for treating severe facial injuries in these circumstances. Facial CTA is recognised as giving huge benefits for patients with severe facial defects with potentially superior results compared with conventional autograft techniques. Its performance in austere settings is limited by scarce resources and increased pre-, intra- and post- operative risks. However, a case can be made for its use even in these more challenging situations when general organ transplantation compliance and expertise input have been addressed.
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Affiliation(s)
| | - T-M. Borg
- Queen Mary University of London, London, UK
| | - P. Sadigh
- Department of Plastic and Reconstructive Surgery, The Royal London Hospital, London, UK
| | - S. Myers
- Queen Mary University of London, London, UK
| | - D.J.. Smith
- University of South Florida, Tampa, Florida, USA
| | - S. Holmes
- Queen Mary University of London, London, UK
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A European perspective of the cost effectiveness of facial composite tissue allotransplantation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01598-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
Facial composite tissue allotransplantation (CTA) may be considered in cases of severe facial injury. To date, no reports have analysed the cost of potential facial CTA in the UK. The aims of this study were to establish (1) the cost implications without facial CTA, necessitating multiple reconstructive procedures in cases with severe facial deformities, and (2) if facial CTA would be cost-effective in the UK given recent European and North American published cost analyses.
Methods
Hospital episodes’ data from two potential candidates for facial CTA were used to calculate cost of treatment. In these cases, severe facial trauma was managed by multiple disciplinary teams performing numerous conventional reconstructive procedures. One case served as an indicator of the cost of primary reconstruction during the immediate post-traumatic episode, from admission until first discharge. The other served as an indicator of the accumulative cost of care following primary reconstruction from first discharge to six years later. Costs incurred served as a guide for the cost of standard reconstruction in the UK. These were compared with the costs of similar reconstructive procedures performed in the USA. This was used with data reporting the cost of facial CTA in the USA and France to predict the cost of facial CTA in the UK.
Results
Analysis revealed a cost benefit for facial CTA in a UK context that would become apparent from the third year post-transplant onwards.
Conclusion
Facial CTA may therefore be a more cost-effective long-term reconstructive option for patients with severe facial defects.
Level of evidence: Level V, risk/prognostic study.
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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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Self-Inflicted Gunshot Wound as a Consideration in the Patient Selection Process for Facial Transplantation. Camb Q Healthc Ethics 2019; 28:450-462. [DOI: 10.1017/s0963180119000379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract:Facial transplantation is emerging as a therapeutic option for self-inflicted gunshot wounds. The self-inflicted nature of this injury raises questions about the appropriate role of self-harm in determining patient eligibility. Potential candidates for facial transplantation undergo extensive psychosocial screening. The presence of a self-inflicted gunshot wound warrants special attention to ensure that a patient is prepared to undergo a demanding procedure that poses significant risk, as well as stringent lifelong management. Herein, we explore the ethics of considering mechanism of injury in the patient selection process, referring to the precedent set forth in solid organ transplantation. We also consider the available evidence regarding outcomes of individuals transplanted for self-inflicted mechanisms of injury in both solid organ and facial transplantation. We conclude that while the presence of a self-inflicted gunshot wound is significant in the overall evaluation of the candidate, it does not on its own warrant exclusion from consideration for a facial transplantation.
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Hadımıoğlu N, Cengiz M, Ramazanoğlu A, Özkan Ö, Ertosun MG, Bilal N, Özkan Ö. Anaesthetic Management for Face Transplantations: The Experience of Akdeniz University. Turk J Anaesthesiol Reanim 2019; 47:228-334. [PMID: 31183470 DOI: 10.5152/tjar.2019.04935] [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] [Received: 06/21/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022] Open
Abstract
Objective Solid organ transplantation is a rescue therapy, whereas face transplantation, as well as other composite tissue allotransplantations, offers treatment options to enhance the quality of life. Difficult airway, severe haemorrhage and prolonged operative length are among the frequently encountered complications of anaesthetic management in patients with a history of multiple reconstructive surgeries. Methods Five face allotransplants that were performed in our institute, arising from four full and one partial face transplantations, were reviewed. The pitfalls encountered before, during and following surgery were then summarised. Results Two of our patients (patients 3 and 4) underwent permanent tracheostomy preoperatively. Transplantation was initiated after surgical tracheostomy under local anaesthesia and under sedation in cases 2 and 5. Patient 1 was orally intubated without difficulty under general anaesthesia and was operated following tracheal cannulation via surgical tracheostomy. Thirteen units of red blood cells were transfused each for patients 2 and 4. Two other patients (patients 1 and 4) each received 5 units of red blood cells. Patient 5, who underwent mid-face transplantation lasting for 7.5 h, was not transfused. No major life-threatening complications were observed intraoperatively or following surgery. Conclusion Face transplantation is a surgical procedure in which anaesthetic management may be problematic. The anaesthetist may encounter difficulties, such as difficult airway, severe bleeding, a prolonged operative time and postoperative complications. Side effects and complications may be reduced by strict follow-up and haemodynamic monitoring of patients.
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Affiliation(s)
- Necmiye Hadımıoğlu
- Department of Anaesthesiology and Reanimation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Melike Cengiz
- Department of Anaesthesiology and Reanimation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Atilla Ramazanoğlu
- Department of Anaesthesiology and Reanimation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Özlenen Özkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mustafa Gökhan Ertosun
- Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Nilgun Bilal
- Akdeniz University Hospital, Transplantation Center, Antalya, Turkey
| | - Ömer Özkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey
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10
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Are We Ready for a Human Head Transplant? The Obstacles That Must Be Overcome. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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11
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Sweeney N, Allen K, Miller B, Nolan T, Sheerin K. Perioperative Nursing Management of Donor and Recipient Patients Undergoing Face Transplantation. AORN J 2017; 106:8-19. [PMID: 28662790 DOI: 10.1016/j.aorn.2017.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/06/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
Individuals with debilitating facial injuries and deformities have achieved significant improvement of aesthetic form and function after undergoing a face transplantation. The involvement of surgical technologists and perioperative nurses in the care of the recipient and donor plays a critical role in the success of these procedures. There are unique challenges that staff members may be presented with when caring for a donor and recipient undergoing a face transplantation, including less comfort with and knowledge of the surgical procedure and instrumentation, an increased amount of equipment and personnel in the OR, donor and recipient admission and discharge care, and increased shift length. At New York University Langone Medical Center, New York, we have developed a comprehensive process to prepare staff members to care for patients undergoing face transplantation.
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12
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Perry BJ, Richburg BD, Pomahac B, Bueno EM, Green JR. The Effects of Lip-Closure Exercise on Lip Strength and Function Following Full Facial Transplantation: A Case Report. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:682-686. [PMID: 28654949 DOI: 10.1044/2017_ajslp-16-0101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/23/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE Facial transplantation is a relatively new option for individuals with severe facial disfigurements. Clinical case studies on existing patients indicate many instances of persistent facial motor impairment for facial expression, speech, and swallowing. These preliminary findings motivate additional research on the impact of lip-strengthening exercises following facial transplantation. METHOD In this study, we assessed the efficacy of an 8-week, biofeedback-driven, lip closure-strengthening exercise program in a single patient 1-year status post-full facial transplantation. Exercise was at 60% of peak strength. Outcome measures included instrumental measures of lip strength and mobility, clinical measures of speech, and patient-reported outcomes in feeding and facial expression. RESULTS Results revealed improvements in labial strength, speed of lip movement, and range of motion during speech. A 3-point improvement in sentence speech intelligibility was also observed following strength-training exercise. The patient reported improvements in her ability to drink from a straw and communicate via facial expression. CONCLUSION These preliminary findings motivate additional research on the efficacy of lip-strengthening exercises following facial transplantation.
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Affiliation(s)
- Bridget J Perry
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Brian D Richburg
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Bohdan Pomahac
- Center for Reconstructive and Restorative Surgery, Brigham and Women's Hospital, Boston, MA
| | - Ericka M Bueno
- Center for Reconstructive and Restorative Surgery, Brigham and Women's Hospital, Boston, MA
| | - Jordan R Green
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
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13
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Explain the epidemiology of severe burn injury in the context of socioeconomic status, gender, age, and burn cause. 2. Describe challenges with burn depth evaluation and novel methods of adjunctive assessment. 3. Summarize the survival and functional outcomes of severe burn injury. 4. State strategies of fluid resuscitation, endpoints to guide fluid titration, and sequelae of overresuscitation. 5. Recognize preventative measures of sepsis. 6. Explain intraoperative strategies to improve patient outcomes, including hemostasis, restrictive transfusion, temperature regulation, skin substitutes, and Meek skin grafting. 7. Translate updates in the pathophysiology of hypertrophic scarring into novel methods of clinical management. 8. Discuss the potential role of free tissue transfer in primary and secondary burn reconstruction. SUMMARY Management of burn-injured patients is a challenging and unique field for plastic surgeons. Significant advances over the past decade have occurred in resuscitation, burn wound management, sepsis, and reconstruction that have improved outcomes and quality of life after thermal injury. However, as patients with larger burns are resuscitated, an increased risk of nosocomial infections, sepsis, compartment syndromes, and venous thromboembolic phenomena have required adjustments in care to maintain quality of life after injury. This article outlines a number of recent developments in burn care that illustrate the evolution of the field to assist plastic surgeons involved in burn care.
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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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15
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Iyer S. Vascularised composite allotransplants: Transplant of upper extremities and face. Indian J Plast Surg 2015; 48:111-8. [PMID: 26424972 PMCID: PMC4564491 DOI: 10.4103/0970-0358.163037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Transplantation of solid organs and bone marrow has become a highly acceptable and often the only available clinical solution in many situations. It has been practiced across the globe for quite a long time since the first kidney transplant in 1954. Transplantation of tissues other than these, which was termed composite tissue allotransplantation and currently as vascularised composite allotransplantation (VCA) is gaining acceptance as a solution for complex reconstructive problems. This involves the transfer of multiple types of tissue such as bone, muscle, nerve, skin and blood vessels. The advantage of these over the conventional reconstructive methods is its ability to give aesthetically and functionally superior equal composite substitute to the missing or deformed part. The composite tissues transplanted commonly include the upper extremities, face and abdominal wall. Among these, hand transplants were the first to be done and have been carried out more than any other VCA. This article reviews the current scenario of VCA especially of the hand and face, in the light of experience of the two bilateral hand transplants done recently in India.
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Affiliation(s)
- Subramania Iyer
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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16
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Iglesias M, Butrón P, Osuna-Leal A, Abarca-Perez L, Sosa-Ascencio M, Moran-Romero M, Cruz-Reyes A, Pineda-Gutierrez F, Leon-Lopez D, García-Alvarez M, Alberu J, Vilatoba M, Leal-Villalpando R, Zamudio-Bautista J, Acosta-Nava V, Gonzalez J. Is Mexico Ready for Face Transplantation? Transplant Proc 2015; 47:1998-2002. [DOI: 10.1016/j.transproceed.2015.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/04/2015] [Accepted: 05/15/2015] [Indexed: 02/05/2023]
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