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Yang AZ, Shelton E, Katave C, Fruge S, Talbot SG, Eberlin KR, Orgill DP, Ranganathan KL. Outcomes of Dermal Regeneration Templates in Irradiated and Nonirradiated Scalp Defects. J Craniofac Surg 2024:00001665-990000000-01426. [PMID: 38563558 DOI: 10.1097/scs.0000000000010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES Dermal regeneration templates (DRTs) are frequently used to treat scalp defects. The aim was to compare the time course of healing for DRTs in scalp defects with and without preoperative radiation. METHODS The authors conducted a retrospective cohort study of DRT-based scalp reconstruction at 2 academic medical centers between 2013 and 2022. Information was collected on demographic variables, comorbidities, medication use, history of radiation, and DRT outcomes. The primary outcome was DRT loss, defined as exposed calvarium or DRT detachment based on postoperative follow-up documentation. Kaplan-Meier survival analysis and multivariable Cox proportional-hazard regressions were used to compare DRT loss in irradiated and nonirradiated defects. Multivariable logistic regressions were used to compare 30-day postoperative complications (infection, hematoma, or seroma) in irradiated and nonirradiated defects. RESULTS In total, 158 cases were included. Twenty-eight (18%) patients had a preoperative history of radiation to the scalp. The mean follow-up time after DRT placement was 2.6 months (SD: 4.5 mo). The estimated probability of DRT survival at 2 months was 91% (95% CI: 83%-100%) in nonirradiated patients and 65% (95% CI: 48%-88%) in irradiated patients. In the 55 patients with a bony wound base, preoperative head radiation was associated with a higher likelihood of DRT loss (hazard ratio: 11). Half the irradiated defects experienced uncomplicated total wound closure using Integra Wound Matrix Dressing with or without second-stage reconstruction. CONCLUSIONS Dermal regeneration template can offer durable coverage in nonirradiated scalp defects. Although DRT loss is more likely in irradiated scalp defects, successful DRT-based reconstruction is possible in select cases.
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Affiliation(s)
- Alan Z Yang
- Division of Plastic and Reconstructive Surgery
| | - Eva Shelton
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Coral Katave
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Seth Fruge
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Simon G Talbot
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Kyle R Eberlin
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | - Dennis P Orgill
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Kavitha L Ranganathan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
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Yu Z, Vieyra-Garcia P, Benezeder T, Crouch JD, Kim IR, O'Malley JT, Devlin PM, Gehad A, Zhan Q, Gudjonsson JE, Sarkar MK, Kahlenberg JM, Gerard N, Teague JE, Kupper TS, LeBoeuf NR, Larocca C, Tawa M, Pomahac B, Talbot SG, Orgill DP, Wolf P, Clark RA. Phototherapy Restores Deficient Type I IFN Production and Enhances Antitumor Responses in Mycosis Fungoides. J Invest Dermatol 2024; 144:621-632.e1. [PMID: 37716650 PMCID: PMC10922223 DOI: 10.1016/j.jid.2023.06.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 09/18/2023]
Abstract
Transcriptional profiling demonstrated markedly reduced type I IFN gene expression in untreated mycosis fungoides (MF) skin lesions compared with that in healthy skin. Type I IFN expression in MF correlated with antigen-presenting cell-associated IRF5 before psoralen plus UVA therapy and epithelial ULBP2 after therapy, suggesting an enhancement of epithelial type I IFN. Immunostains confirmed reduced baseline type I IFN production in MF and increased levels after psoralen plus UVA treatment in responding patients. Effective tumor clearance was associated with increased type I IFN expression, enhanced recruitment of CD8+ T cells into skin lesions, and expression of genes associated with antigen-specific T-cell activation. IFNk, a keratinocyte-derived inducer of type I IFNs, was increased by psoralen plus UVA therapy and expression correlated with upregulation of other type I IFNs. In vitro, deletion of keratinocyte IFNk decreased baseline and UVA-induced expression of type I IFN and IFN response genes. In summary, we find a baseline deficit in type I IFN production in MF that is restored by psoralen plus UVA therapy and correlates with enhanced antitumor responses. This may explain why MF generally develops in sun-protected skin and suggests that drugs that increase epithelial type I IFNs, including topical MEK and EGFR inhibitors, may be effective therapies for MF.
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Affiliation(s)
- Zizi Yu
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pablo Vieyra-Garcia
- Research Unit for Photodermatology, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Theresa Benezeder
- Research Unit for Photodermatology, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Jack D Crouch
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ira R Kim
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John T O'Malley
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip M Devlin
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed Gehad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Qian Zhan
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mrinal K Sarkar
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - J Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nega Gerard
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica E Teague
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Center for Cutaneous Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Center for Cutaneous Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Cecilia Larocca
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Center for Cutaneous Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Marianne Tawa
- Center for Cutaneous Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Bohdan Pomahac
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Simon G Talbot
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis P Orgill
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Wolf
- Research Unit for Photodermatology, Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria.
| | - Rachael A Clark
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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3
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Zuo KJ, Leonard DA, Shores JT, Talbot SG. The Nuances of Hand Transplantation After Sepsis. Transplantation 2024; 108:319-322. [PMID: 37271881 DOI: 10.1097/tp.0000000000004665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Vascularized composite allotransplantation (VCA) of the upper extremity is an established restorative procedure for selected patients with acquired upper limb loss. The majority of upper limb VCAs performed worldwide have been for victims of various forms of trauma. However, in the developed world, amputation following severe sepsis seems to be an increasingly common indication for referral to hand transplant programs. Unlike trauma patients with isolated limb injuries, patients with amputations as a complication of sepsis have survived through a state of global tissue hypoperfusion and multisystem organ failure with severe, enduring effects on the entire body's physiology. This article reviews the unique considerations for VCA candidacy in postsepsis patients with upper limb amputation. These insights may also be relevant to postsepsis patients undergoing other forms of transplantation or to VCA patients requiring additional future solid organ transplants.
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Affiliation(s)
- Kevin J Zuo
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - David A Leonard
- Hand Transplant UK, Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Jaimie T Shores
- Hand/Arm Transplant Program, Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Simon G Talbot
- Upper Extremity Transplant Program, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA
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Rinkinen JR, Fruge S, Welten VM, Kinsley S, Bleday R, Irani J, Yoo J, Goldberg JE, Melnitchouk N, Talbot SG. Long-term outcomes analysis of flap-based perineal reconstruction. J Gastrointest Surg 2024; 28:57-63. [PMID: 38353075 DOI: 10.1016/j.gassur.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND High-risk patients undergoing abdominoperineal resection and pelvic exenteration may benefit from immediate flap reconstruction. However, there is currently no consensus on the ideal flap choice or patient for whom this is necessary. This study aimed to evaluate the long-term outcomes of using pedicled gracilis flaps for pelvic reconstruction and to analyze predictors of postoperative complications. METHODS This was a retrospective review of a single reconstructive surgeon's cases between January 2012 and June 2021 identifying patients who underwent perineal reconstruction secondary to oncologic resection. Preoperative and outcome variables were collected and analyzed to determine the risk of developing minor and major wound complications. RESULTS A total of 101 patients were included in the study with most patients (n = 88) undergoing unilateral gracilis flap reconstruction after oncologic resection. The mean follow-up period was 75 months. Of 101 patients, 8 (7.9%) developed early major complications, and an additional 13 (12.9%) developed late major complications. Minor complications developed in 33 patients (32.7%) with most cases being minor wound breakdown requiring local wound care. Most patients (n = 92, 91.1%) did not develop donor site complications. Anal cancer was significantly associated with early major complications, whereas younger age and elevated body mass index were significant predictors of developing minor wound complications. CONCLUSIONS This study builds on our previous work that demonstrated the long-term success rate of gracilis flap reconstruction after large pelvic oncologic resections. A few patients developed donor site complications, and perineal complications were usually easily managed with local wound care, thus making the gracilis flap an attractive alternative to abdominal-based flaps.
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Affiliation(s)
- Jacob R Rinkinen
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Seth Fruge
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Vanessa M Welten
- Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Sarah Kinsley
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Ronald Bleday
- Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Jennifer Irani
- Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - James Yoo
- Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Joel E Goldberg
- Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Nelya Melnitchouk
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Simon G Talbot
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States.
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Lennon RP, Parascando J, Talbot SG, Zhou S, Wasserman E, Mantri S, Day PG, Liu R, Lagerman M, Appiah A, Rabago D, Dean W. Prevalence of Moral Injury, Burnout, Anxiety, and Depression in Healthcare Workers 2 Years in to the COVID-19 Pandemic. J Nerv Ment Dis 2023; 211:981-984. [PMID: 38015191 DOI: 10.1097/nmd.0000000000001705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT COVID-19 has led to marked increases in healthcare worker distress. Studies of these phenomena are often limited to a particular element of distress or a specific subset of healthcare workers. We administered the Moral Injury Symptom Scale for Healthcare Professionals, Copenhagen Burnout Inventory, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 via online survey to 17,000 employees of a large academic medical center between December 2021 and February 2022. A total of 1945 participants completed the survey. Across all roles, the prevalence of moral injury, burnout, depression, and anxiety were 40.9%, 35.3%-60.6%, 25.4%, and 24.8%, respectively. Furthermore, 8.1% had been bothered by thoughts that they would be better off dead or of hurting themselves for "several days" or more frequently. Healthcare workers across all roles and practice settings are experiencing unsustainable levels of distress, with 1 in 12 regularly experiencing thoughts of self-harm.
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Affiliation(s)
- Robert P Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jessica Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Simon G Talbot
- Division of Plastic Surgery, Harvard Medical School Brigham and Women's Hospital, Boston, Massachusetts
| | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Sneha Mantri
- Department of Neurology and Trent Center for Bioethics, Duke University School of Medicine, Durham, North Carolina
| | - Philip G Day
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Ryan Liu
- Department of Family and Community Medicine, Penn State Health St Joseph Medical Center, Reading, Pennsylvania
| | - Makayla Lagerman
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Annette Appiah
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - David Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Wendy Dean
- Moral Injury of Healthcare, Carlisle, Pennsylvania
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Affiliation(s)
| | - Michael J Healey
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon G Talbot
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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7
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Burrowes SAB, Casey SM, Pierre-Joseph N, Talbot SG, Hall T, Christian-Brathwaite N, Del-Carmen M, Garofalo C, Lundberg B, Mehta PK, Mottl-Santiago J, Schechter-Perkins EM, Weber A, Yarrington CD, Perkins RB. COVID-19 pandemic impacts on mental health, burnout, and longevity in the workplace among healthcare workers: A mixed methods study. J Interprof Educ Pract 2023; 32:100661. [PMID: 37305404 PMCID: PMC10248469 DOI: 10.1016/j.xjep.2023.100661] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/07/2023] [Indexed: 06/13/2023]
Abstract
To explore the mental health impacts of the COVID-19 pandemic on healthcare workers in Massachusetts and identify potential strategies to maintain the healthcare workforce we conducted a sequential exploratory mixed methods study. Fifty-two individuals completed interviews from April 22nd - September 7th, 2021; 209 individuals completed an online survey from February 17th - March 23rd, 2022. Interviews and surveys asked about the mental health impacts of working in healthcare during the COVID-19 pandemic, burnout, longevity in the workplace, and strategies for reducing attrition. Interview and survey participants were predominantly White (56%; 73%, respectively), female (79%; 81%) and worked as physicians (37%; 34%). Interviewees indicated high stress and anxiety levels due to frequent exposure to patient deaths from COVID-19. Among survey respondents, 55% reported worse mental health than before the pandemic, 29% reported a new/worsening mental health condition for themselves or their family, 59% reported feeling burned out at least weekly, and 37% intended to leave healthcare in less than 5 years. To decrease attrition, respondents suggested higher salaries (91%), flexible schedules (90%), and increased support to care for patients (89%). Healthcare workers' experiences with death, feeling unvalued, and overworked resulted in unprecedented rates of burnout and intention to leave healthcare.
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Affiliation(s)
- Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sharon M Casey
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Natalie Pierre-Joseph
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Simon G Talbot
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Taylor Hall
- Graduate Medical Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | | | - Marcela Del-Carmen
- Division of Gynecologic Oncology, Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Garofalo
- Department of Family Medicine and Department of Obstetrics and Gynecology at Sturdy Memorial Hospital, Attleboro, MA, USA
- Family Medicine Associates of South Attleboro, South Attleboro, Massachusetts, USA
| | | | - Pooja K Mehta
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
- Cityblock Health, Brooklyn, NY, USA
| | - Julie Mottl-Santiago
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Elissa M Schechter-Perkins
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Ariana Weber
- Department of Emergency Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Christina D Yarrington
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
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Kinsley SE, Song S, Losina E, Talbot SG. Psychosocial Risk Stratification in Upper Extremity Transplantation Candidates. Hand (N Y) 2023:15589447231184895. [PMID: 37415342 DOI: 10.1177/15589447231184895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Candidate selection for upper extremity transplantation remains an inherently subjective process. This work evaluated the effect that psychosocial factors have on outcomes, both to standardize evaluation of potential candidates and in optimizing these factors prior to transplantation. Our goal was to measure and quantify the risk that various psychosocial factors have on transplant outcomes. METHODS Given that we do not have sufficient post-transplant patients to examine specific factors, we chose to have experts in the field evaluate hypothetical patients based on their experience. We used a Generalized Estimating Equation to estimate and compare surgical candidacy scores using patient scenario vignettes based on the presence or absence of permutations of the following: (1) depression; (2) participation in occupational therapy (OT); (3) expectation of post-transplant function; (4) punctuality; and (5) family support were given to experts in the field. RESULTS This work suggests there is a decrease in predicted success with increasing numbers of negative factors with participation in OT and realistic expectations of outcomes being most important. An increase in the summarizing risk score from 0 to 1.7 was associated with a decrease in the outcome surgical candidacy score from 8.6 to 5.3, meaning candidates with 2 risk factors would often observe a large drop in surgical candidacy score. CONCLUSIONS Focusing on optimizing psychosocial variables in transplant candidates may help improve hand transplant success.
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Affiliation(s)
| | - Shuang Song
- Brigham and Women's Hospital, Boston, MA, USA
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Kumnig M, Hummel NR, Jowsey-Gregoire SG, Zuo KJ, Gordon EJ, Talbot SG. Editorial: Psychosocial and bioethical challenges and developments for the future of vascularized composite allotransplantations. Front Psychol 2023; 14:1186113. [PMID: 37151323 PMCID: PMC10157283 DOI: 10.3389/fpsyg.2023.1186113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Martin Kumnig
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Center for Advanced Psychology Transplantation Medicine (CAPTM), Medical University of Innsbruck, Innsbruck, Austria
- *Correspondence: Martin Kumnig
| | - Nikolas R. Hummel
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Center for Advanced Psychology Transplantation Medicine (CAPTM), Medical University of Innsbruck, Innsbruck, Austria
| | - Sheila G. Jowsey-Gregoire
- Department of Psychiatry and Psychology, Mayo Graduate School of Medicine, Mayo Clinic Rochester, Rochester, MN, United States
| | - Kevin J. Zuo
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Elisa J. Gordon
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Simon G. Talbot
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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10
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Kumnig M, Jowsey-Gregoire SG, Bellew M, Dean W, Järvholm S, Coffman K, Brown C, Moreno E, Talbot SG, Morelon E, Petruzzo P, Amer H. The Chauvet Workgroup: A Resource for the Psychosocial Aspects of Reconstructive Transplantation. Mayo Clin Proc 2022; 97:1050-1053. [PMID: 35662423 DOI: 10.1016/j.mayocp.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 12/24/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Martin Kumnig
- Innsbruck Medical University, Department of Medical Psychology, Center for Advanced Psychology in Plastic and Transplant Surgery, Innsbruck, Austria
| | - Sheila G Jowsey-Gregoire
- Essam and Dalal Obaid Center for Reconstructive Transplant Surgery and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
| | - Maggie Bellew
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Wendy Dean
- Moral Injury of Healthcare, Carlisle, PA
| | - Stina Järvholm
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kathy Coffman
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH
| | - Charlotte Brown
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Elisa Moreno
- Departments of Psychiatry and Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Simon G Talbot
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Emmanuel Morelon
- Department of Transplantation, Nephrology and Clinical Immunology, Hôpital Édouard Herriot, Lyon, France
| | - Palmina Petruzzo
- Department of Transplantation, Nephrology and Clinical Immunology, Hôpital Édouard Herriot, Lyon, France; Department of Surgery, University of Cagliari, Italy
| | - Hatem Amer
- Essam and Dalal Obaid Center for Reconstructive Transplant Surgery and the William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
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11
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Kinsley SE, Williams EE, Lenhard NK, Shah SB, Edwards RR, Katz JN, Talbot SG. A Provider Perspective of Psychosocial Predictors of Upper-Extremity Vascularized Composite Allotransplantation Success. J Hand Surg Am 2022; 47:387.e1-387.e19. [PMID: 34266683 DOI: 10.1016/j.jhsa.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/14/2021] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We performed a qualitative study to understand the psychosocial factors associated with success in upper-extremity vascularized composite allotransplantation from the perspective of transplant providers. METHODS We recruited 13 providers actively involved in upper-extremity vascularized composite allotransplantation. Participants included physicians, nurses, social workers, occupational therapists, and research administrators. We conducted semistructured face-to-face focus group interviews using a guide that explored providers' perceptions of qualities contributing to transplant outcome. Topics included social support networks and their influence on recovery, barriers to treatment compliance and successful posttransplant rehabilitation, and the process of setting patients' expectations. We performed a thematic analysis that produced a list of themes, subthemes, and proposed hypotheses explaining how the themes related to the study's guiding questions. RESULTS The analysis identified numerous factors that contribute to transplant success: (1) recipients' prior experiences modify their ability to cope and adapt after transplantation, (2) behaviors and characteristics such as positivity influence candidacy and may be predictive of successful outcomes, and (3) social support is essential for improved function and compliance. The provider care team cited difficulty in predicting recipient compliance and in setting realistic expectations. CONCLUSIONS Motivated recipients with developed coping and resiliency, a positive attitude, and stable, physically-able caregivers are perceived by providers to have greater success after transplantation. CLINICAL RELEVANCE Findings from this work may help providers determine optimal candidates for upper-extremity vascularized composite allotransplantation.
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Affiliation(s)
- Sarah E Kinsley
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Emma E Williams
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Nora K Lenhard
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Sejal B Shah
- Department of Psychiatry; Brigham and Women's Hospital, Boston, MA
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Boston, MA
| | - Jeffrey N Katz
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Simon G Talbot
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA.
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12
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Faletsky A, Han JJ, Lee KJ, Zhou G, Singer S, Talbot SG, Mostaghimi A. Crowdfunding for Gender-Affirming Mastectomy: Balancing Fundraising With Loss of Privacy. Ann Plast Surg 2022; 88:372-374. [PMID: 34270468 DOI: 10.1097/sap.0000000000002953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Limitations in insurance coverage may cause patients to turn to crowdfunding to raise money for gender-affirming procedures. In this study, we analyze the impact of Medicaid insurance coverage on gender-affirming mastectomy campaigns posted on GoFundMe.com. METHODS Between March 1 and 12, 2021, we accessed GoFundMe.com to analyze available campaigns requesting monetary contributions for gender-affirming mastectomy. Campaigns were identified using the search term "top surgery" followed by the state's name. Duplicate campaigns, campaigns whose primary goal was not gender-affirming mastectomy, and ongoing campaigns were excluded. Campaigns were then categorized according to their state's coverage of gender-affirming surgery: explicit exclusion (EE), explicit inclusion (EI), or no explicit statement of gender-affirming care. We collected data on the number of donors and shares, the fundraising goal, and the total amount raised for each campaign. Common themes within campaign narratives were identified and assessed by each reviewer. Finally, we collected data on the photographs posted by campaign creators. RESULTS Our search yielded 790 campaigns, with an overall mean of 58 ± 99 donors and 212 ± 288 shares. The mean fundraising goal and amount raised among all campaigns were $6811 ± $5027 and $2579 ± $3072, respectively. Fundraising goals were most likely to be met in an EI state than an EE state (26.3% vs 8.1%; P < 0.001). The mean amount sought was highest in EE states and lowest in EI states, whereas the mean amount raised was lowest in EE states and highest in EI states. Of the campaigns, 97.1% mentioned personal or situational characteristics in the narrative section; 16.2% of all campaigns expressed negative feelings about posting on GoFundMe.com to raise money for their surgeries. CONCLUSION Disparities in health care coverage of gender-affirming surgeries were seen between state categories, with a decreased need for crowdfunding in states explicitly including coverage of gender-affirming surgery. Many transgender patients used crowdfunding to pay for transition-related health care costs, relying on the kindness of strangers and their social network at the expense of their personal privacy. Expansion of legislative coverage of gender-affirming surgeries may alleviate some of this financial burden and reduce transgender patients' reliance on crowdfunding campaigns.
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Affiliation(s)
| | | | - Karen J Lee
- From the Department of Dermatology, Brigham and Women's Hospital
| | - Guohai Zhou
- From the Department of Dermatology, Brigham and Women's Hospital
| | - Sean Singer
- From the Department of Dermatology, Brigham and Women's Hospital
| | - Simon G Talbot
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Arash Mostaghimi
- From the Department of Dermatology, Brigham and Women's Hospital
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13
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Borges TJ, Abarzua P, Gassen RB, Kollar B, Lima-Filho M, Aoyama BT, Gluhova D, Clark RA, Islam SA, Pomahac B, Murphy GF, Lian CG, Talbot SG, Riella LV. T cell-attracting CCL18 chemokine is a dominant rejection signal during limb transplantation. Cell Rep Med 2022; 3:100559. [PMID: 35492875 PMCID: PMC9040185 DOI: 10.1016/j.xcrm.2022.100559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/14/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022]
Abstract
Limb transplantation is a life-changing procedure for amputees. However, limb recipients have a 6-fold greater rejection rate than solid organ transplant recipients, related in part to greater immunogenicity of the skin. Here, we report a detailed immunological and molecular characterization of individuals who underwent bilateral limb transplantation at our institution. Circulating Th17 cells are increased in limb transplant recipients over time. Molecular characterization of 770 genes in skin biopsies reveals upregulation of T cell effector immune molecules and chemokines, particularly CCL18. Skin antigen-presenting cells primarily express the chemokine CCL18, which binds to the CCR8 receptor. CCL18 treatment recruits more allo-T cells to the skin xenograft in a humanized skin transplantation model, leading to signs of accelerated graft rejection. Blockade of CCR8 remarkedly decreases CCL18-induced allo-T cell infiltration. Our results suggest that targeting the CCL18:CCR8 pathway could be a promising immunosuppressive approach in transplantation.
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Affiliation(s)
- Thiago J. Borges
- Schuster Family Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Phammela Abarzua
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Rodrigo B. Gassen
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Branislav Kollar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, University of Freiburg Faculty of Medicine, 79106 Freiburg, Germany
| | - Mauricio Lima-Filho
- Schuster Family Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Bruno T. Aoyama
- Schuster Family Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Diana Gluhova
- DF/HCC Specialized Histopathology Core – Massachusetts General Hospital Site, Boston, MA 02129, USA
| | - Rachael A. Clark
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston MA 02115, USA
| | - Sabina A. Islam
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - George F. Murphy
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Christine G. Lian
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Simon G. Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Leonardo V. Riella
- Schuster Family Transplantation Research Center, Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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14
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Kinsley SE, Lenhard NK, Lape EC, Shah SB, Edwards RR, Katz JN, Talbot SG. Perceived Success in Upper-Extremity Vascularized Composite Allotransplantation: A Qualitative Study. J Hand Surg Am 2021; 46:711.e1-711.e35. [PMID: 33722470 DOI: 10.1016/j.jhsa.2021.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We performed a qualitative study to understand psychosocial factors associated with perceived success of upper-extremity vascularized composite allotransplantation (VCA). We interviewed transplant recipients and their primary caregivers. METHODS We recruited 4 upper-extremity VCA recipients and primary caregivers for 3 of them. We conducted semistructured face-to-face interviews using a guide that explored participants' transplantation experiences. Topics included comparison of pretransplant and posttransplant expectations, reflections on factors contributing to the success of the transplant experience, and posttransplant rehabilitation and functioning. We performed a thematic analysis that produced a list of themes, subthemes, and proposed hypotheses explaining how the themes related to the study's guiding questions. RESULTS Participants described several factors as contributing to the success of the transplant experience, including developing realistic expectations about posttransplant function and lifelong immunosuppression, support from one's community and particularly the primary caregiver, and framing the experience in a positive light. Social, aesthetic, and other values unique to the hands, as opposed to prosthetics, motivated recipients to undergo VCA despite its inherent risk and uncertainties. CONCLUSIONS Despite inherent challenges, undergoing VCA was viewed as worthwhile to regain benefits unique to hands. Participants met the challenges of the transplant process through setting realistic expectations, strong social support, and a positive perspective. CLINICAL RELEVANCE Findings from this work may help clinicians and prospective patients to prepare for and set appropriate expectations of VCA.
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Affiliation(s)
- Sarah E Kinsley
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Nora K Lenhard
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Emma C Lape
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Sejal B Shah
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Robert R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Boston, MA
| | - Jeffrey N Katz
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Simon G Talbot
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA.
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15
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Greyson MA, Kinsley S, Talbot SG. Thumb reconstruction by "on-top-plasty" of the long finger. Case Reports Plast Surg Hand Surg 2021; 8:87-92. [PMID: 34291122 PMCID: PMC8274534 DOI: 10.1080/23320885.2021.1935965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A 61 year old man sustained electrical burns to hands requiring amputation of the right thumb and index finger at the metacarpophalangeal level. The thumb was reconstructed by means of on-top-plasty of the long finger. This is a reliable and safe technique in selected patients with severe, traumatic hand injuries.
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Affiliation(s)
- Mark A Greyson
- Division of Plastic SurgeryDivision of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Kinsley
- Division of Plastic SurgeryDivision of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon G Talbot
- Division of Plastic SurgeryDivision of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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16
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Cotton RN, Wegrecki M, Cheng TY, Chen YL, Veerapen N, Le Nours J, Orgill DP, Pomahac B, Talbot SG, Willis R, Altman JD, de Jong A, Van Rhijn I, Clark RA, Besra GS, Ogg G, Rossjohn J, Moody DB. CD1a selectively captures endogenous cellular lipids that broadly block T cell response. J Exp Med 2021; 218:e20202699. [PMID: 33961028 PMCID: PMC8111460 DOI: 10.1084/jem.20202699] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/12/2021] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
We optimized lipidomics methods to broadly detect endogenous lipids bound to cellular CD1a proteins. Whereas membrane phospholipids dominate in cells, CD1a preferentially captured sphingolipids, especially a C42, doubly unsaturated sphingomyelin (42:2 SM). The natural 42:2 SM but not the more common 34:1 SM blocked CD1a tetramer binding to T cells in all human subjects tested. Thus, cellular CD1a selectively captures a particular endogenous lipid that broadly blocks its binding to TCRs. Crystal structures show that the short cellular SMs stabilized a triad of surface residues to remain flush with CD1a, but the longer lipids forced the phosphocholine group to ride above the display platform to hinder TCR approach. Whereas nearly all models emphasize antigen-mediated T cell activation, we propose that the CD1a system has intrinsic autoreactivity and is negatively regulated by natural endogenous inhibitors selectively bound in its cleft. Further, the detailed chemical structures of natural blockers could guide future design of therapeutic blockers of CD1a response.
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Affiliation(s)
- Rachel N. Cotton
- Graduate Program in Immunology, Harvard Medical School, Boston, MA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Marcin Wegrecki
- Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Victoria, Australia
| | - Tan-Yun Cheng
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Yi-Ling Chen
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Natacha Veerapen
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jérôme Le Nours
- Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Victoria, Australia
| | - Dennis P. Orgill
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Simon G. Talbot
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Richard Willis
- National Institutes of Health Tetramer Core Facility, Emory University, Atlanta, GA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
- Yerkes National Primate Research Center, Emory University, Atlanta, GA
| | - John D. Altman
- National Institutes of Health Tetramer Core Facility, Emory University, Atlanta, GA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA
- Yerkes National Primate Research Center, Emory University, Atlanta, GA
| | - Annemieke de Jong
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Ildiko Van Rhijn
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Rachael A. Clark
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Gurdyal S. Besra
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Graham Ogg
- Medical Research Council Human Immunology Unit, Medical Research Council Weatherall Institute of Molecular Medicine, National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Jamie Rossjohn
- Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Victoria, Australia
- Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff, UK
| | - D. Branch Moody
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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17
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Cotton RN, Cheng TY, Wegrecki M, Le Nours J, Orgill DP, Pomahac B, Talbot SG, Willis RA, Altman JD, de Jong A, Ogg G, Van Rhijn I, Rossjohn J, Clark RA, Moody DB. Human skin is colonized by T cells that recognize CD1a independently of lipid. J Clin Invest 2021; 131:140706. [PMID: 33393500 PMCID: PMC7773353 DOI: 10.1172/jci140706] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022] Open
Abstract
CD1a-autoreactive T cells contribute to skin disease, but the identity of immunodominant self-lipid antigens and their mode of recognition are not yet solved. In most models, MHC and CD1 proteins serve as display platforms for smaller antigens. Here, we showed that CD1a tetramers without added antigen stained large T cell pools in every subject tested, accounting for approximately 1% of skin T cells. The mechanism of tetramer binding to T cells did not require any defined antigen. Binding occurred with approximately 100 lipid ligands carried by CD1a proteins, but could be tuned upward or downward with certain natural self-lipids. TCR recognition mapped to the outer A' roof of CD1a at sites remote from the antigen exit portal, explaining how TCRs can bind CD1a rather than carried lipids. Thus, a major antigenic target of CD1a T cell autoreactivity in vivo is CD1a itself. Based on their high frequency and prevalence among donors, we conclude that CD1a-specific, lipid-independent T cells are a normal component of the human skin T cell repertoire. Bypassing the need to select antigens and effector molecules, CD1a tetramers represent a simple method to track such CD1a-specific T cells from tissues and in any clinical disease.
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Affiliation(s)
- Rachel N. Cotton
- Graduate Program in Immunology, Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tan-Yun Cheng
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcin Wegrecki
- Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Victoria, Australia
| | - Jérôme Le Nours
- Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Victoria, Australia
| | - Dennis P. Orgill
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts, USA
| | - Bohdan Pomahac
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts, USA
| | - Simon G. Talbot
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston Massachusetts, USA
| | - Richard A. Willis
- NIH Tetramer Core Facility, Emory University, Atlanta, Georgia, USA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
- Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - John D. Altman
- NIH Tetramer Core Facility, Emory University, Atlanta, Georgia, USA
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
- Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Annemieke de Jong
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Graham Ogg
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, United Kingdom
| | - Ildiko Van Rhijn
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- School of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jamie Rossjohn
- Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Victoria, Australia
- Institute of Infection and Immunity, Cardiff University, School of Medicine, Heath Park, Cardiff, United Kingdom
| | - Rachael A. Clark
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - D. Branch Moody
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Kinsley SE, Fernicola SD, Dingle ME, Williams MS, Richardson JM, Taylor D, de Vasconcellos JF, Malone TR, Blattner MR, Smith JK, Oliver A, Koch AL, Riddle LE, Reiter C, Culp WE, Caterson EJ, Nesti LJ, Talbot SG. A Yorkshire swine (Sus scrofa domesticus) model for nerve regeneration and ischemia based on the sciatic nerve and femoral artery. Ann Anat 2021; 233:151587. [DOI: 10.1016/j.aanat.2020.151587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
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19
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Heineman J, Bueno EM, Kiwanuka H, Carty MJ, Sampson CE, Pribaz JJ, Pomahac B, Talbot SG. All hands on deck: Hand replantation versus transplantation. SAGE Open Med 2020; 8:2050312120926351. [PMID: 32537157 PMCID: PMC7268554 DOI: 10.1177/2050312120926351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 01/07/2023] Open
Abstract
Objectives: Our hands play a remarkable role in our activities of daily living and the
make-up of our identities. In the United States, an estimated 41,000
individuals live with upper limb loss. Our expanding experience in limb
transplantation—including operative techniques, rehabilitation, and expected
outcomes—has often been based on our past experience with replantation.
Here, we undertake a systematic review of replantation with transplantation
in an attempt to better understand the determinants of outcome for each and
to provide a summary of the data to this point. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines, we conducted PubMed searches from 1964 to 2013 for articles in
English. In total, 53 primary and secondary source articles were found to
involve surgical repair (either replantation or transplantation) for
complete amputations at the wrist and forearm levels. All were read and
analyzed. Results: Hand replantations and transplantations were compared with respect to
pre-operative considerations, surgical techniques, post-operative
considerations and outcomes, including motor, sensation, cosmesis, patient
satisfaction/quality of life, adverse events/side effects, financial costs,
and overall function. While comparison of data is limited by heterogeneity,
these data support our belief that good outcomes depend on patient
expectations and commitment. Conclusion: When possible, hand replantation remains the primary option after acute
amputation. However, when replantation fails or is not possible, hand
transplantation appears to provide at least equal outcomes. Patient
commitment, realistic expectations, and physician competence must coincide
to achieve the best possible outcomes for both hand replantation and
transplantation.
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Affiliation(s)
- John Heineman
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ericka M Bueno
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Harriet Kiwanuka
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew J Carty
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian E Sampson
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Julian J Pribaz
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Simon G Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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20
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Affiliation(s)
- Wendy Dean
- Moral Injury of Healthcare LLC, Carlisle, Pennsylvania
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21
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Affiliation(s)
- Wendy Dean
- Moral Injury of Healthcare, Carlisle, PA, USA
| | - Simon G Talbot
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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22
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Pickrell BB, Talbot SG, Costigan DC, Sampson CE. Pacinian hyperplasia presenting with Raynaud's phenomenon. Case Reports Plast Surg Hand Surg 2019; 6:148-152. [PMID: 32002464 PMCID: PMC6968677 DOI: 10.1080/23320885.2019.1698958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
Pacinian corpuscle pathology is a rare clinical entity and an uncommonly reported cause of digital pain. While many prior reports implicate hand trauma, we describe a case of Pacinian hyperplasia found in a patient with Raynaud's phenomenon and propose a potential mechanism of disease.
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Affiliation(s)
- Brent B Pickrell
- Division of Plastic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Simon G Talbot
- Division of Plastic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Danielle C Costigan
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian E Sampson
- Division of Plastic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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23
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Kollar B, Uffing A, Borges TJ, Shubin AV, Aoyama BT, Dagot C, Haug V, Kauke M, Safi AF, Talbot SG, Morelon E, Dakpe S, Pomahac B, Riella LV. MMP3 Is a Non-invasive Biomarker of Rejection in Skin-Bearing Vascularized Composite Allotransplantation: A Multicenter Validation Study. Front Immunol 2019; 10:2771. [PMID: 31849957 PMCID: PMC6897344 DOI: 10.3389/fimmu.2019.02771] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
Background: There is unmet need for non-invasive immunomonitoring to improve diagnosis and treatment of acute rejection in vascularized composite allotransplantation (VCA). Circulating matrix metalloproteinase 3 (MMP3) was described as a candidate non-invasive biomarker to predict treatment response to acute rejection in clinical VCA. However, larger validation studies are yet to be reported to allow for more definitive conclusions. Methods: We retrospectively measured MMP3 levels using ELISA in a total of 140 longitudinal serum samples from six internal and three external face transplant recipients, as well as three internal and seven external upper extremity transplant recipients. The control groups comprised serum samples from 36 kidney transplant recipients, 14 healthy controls, and 38 patients with autoimmune skin disease. A linear mixed model was used to study the effect of rejection state (pre-transplant, no-rejection, non-severe rejection (NSR), and severe rejection) on MMP3 levels. Results: In VCA, MMP3 levels increased significantly (p < 0.001) between pre- and post-transplant no-rejection states. A further increase occurred during severe rejection (p < 0.001), while there was no difference in MMP3 levels between non-severe and no-rejection episodes. A threshold of 5-fold increase from pre-transplant levels could discriminate severe from NSR with 76% sensitivity and 81% specificity (AUC = 0.79, 95% CI = 0.65–0.92, p < 0.001). In kidney transplantation, the MMP3 levels were significantly (p < 0.001) elevated during antibody-mediated rejection but not during T-cell mediated rejection (TCMR) (p = 0.547). MMP3 levels in healthy controls and autoimmune skin disease patients were comparable with either pre-transplant or no-rejection/NSR episodes of VCA patients. Conclusion: The results of this study suggest that serum MMP3 protein is a promising marker for stratifying patients according to severity of rejection, complementary to biopsy findings.
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Affiliation(s)
- Branislav Kollar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Audrey Uffing
- Renal Division, Schuster Transplantation Research Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Thiago J Borges
- Renal Division, Schuster Transplantation Research Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Andrey V Shubin
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | - Bruno T Aoyama
- Renal Division, Schuster Transplantation Research Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Céline Dagot
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.,Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Martin Kauke
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ali-Farid Safi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Simon G Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Emmanuel Morelon
- Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Stéphanie Dakpe
- Department of Maxillo-Facial Surgery, Amiens University Hospital, Amiens, France
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Leonardo V Riella
- Renal Division, Schuster Transplantation Research Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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Dorante MI, Devine E, Talbot SG. Should a Caregiver's QoL Be Considered in Decisions About Whether a Patient Has an Experimental Double-Hand Transplant? AMA J Ethics 2019; 21:E943-952. [PMID: 31742542 DOI: 10.1001/amajethics.2019.943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A goal of hand and upper extremity transplantation is to return motor and sensory function to an amputee. Given the integral roles of one's hands in activities of daily living and social interaction, however, restoring psychosocial well-being should also be a priority. Based on the authors' experience, double-hand transplantation success depends significantly on strong social support, physical rehabilitation, medication adherence, and social integration. Because caregiving is demanding, tasks should be distributed among members of a patient's family and social network. This article analyzes how to respond to an overwhelmed caregiver by drawing on solid organ transplant literature about caregiver fatigue.
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Affiliation(s)
- Miguel I Dorante
- A bioethicist and plastic and reconstructive surgery resident at Lahey Hospital and Medical Center in Burlington, Massachusetts, and a research fellow with the Center for Reconstructive and Restorative Surgery Research at Brigham and Women's Hospital
| | - Elaine Devine
- A clinical social worker for the Brigham and Women's Hospital face and extremity transplant program in Boston, Massachusetts
| | - Simon G Talbot
- A plastic and reconstructive surgeon at Brigham and Women's Hospital in Boston, Massachusetts, where he is the director of the Upper Extremity Transplant Program, and an associate professor of surgery at Harvard Medical School
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Rose J, Cooney CM, Kaufman C, Talbot SG, Caplan A, Kahn J, Sugarman J, Shores JT, Levin LS, Brandacher G, McDiarmid SV, Lee WPA, Dean W. Evolving ethics, policy and reimbursement issues of vascularized composite allotransplantation: Symposium summary. SAGE Open Med 2019. [PMID: 31384465 PMCID: PMC6661784 DOI: 10.1177/2050312119866944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this article, we present a report from a national meeting titled, “Evolving Issues of Vascularized Composite Allotransplantation—A Symposium on Ethics, Policy, and Reimbursement Issues,” which convened in September 2017. We discuss the maturation of vascularized composite allotransplantation from an emerging technology to becoming an extension of clinical practice for select patients with complex reconstructive needs. Viewpoints and action items were presented by and discussed among the 70+ clinicians, researchers, policymakers, ethicists, healthcare administrators, and third-party payers who attended the symposium with the goals of implementing a collaborative roadmap for vascularized composite allotransplantation growth, evaluation, and sustainability by establishing a unified plan to help address concerns of the public, policymakers, and healthcare finance. We review the current status of vascularized composite allotransplantation in clinical practice and summarize symposium discussions regarding ethical considerations, reimbursement, payer strategies, and standardization of data collection.
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Affiliation(s)
- John Rose
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christina Kaufman
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA
| | - Simon G Talbot
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Arthur Caplan
- Division of Medical Ethics, New York University School of Medicine, New York City, NY, USA
| | - Jeffrey Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L Scott Levin
- Department of Orthopaedic Surgery, Division of Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sue V McDiarmid
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics and Surgery. David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - WP Andrew Lee
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy Dean
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
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Talbot SG, Carty MJ, Jensen SE, Dumanian GA. Adjustment to amputation and interest in upper limb transplantation. SAGE Open Med 2019; 7:2050312119858248. [PMID: 31217973 PMCID: PMC6563387 DOI: 10.1177/2050312119858248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: Upper limb transplantation provides a new restorative option for individuals with amputations. As true for most operations, patient selection is critical to optimizing transplantation outcomes. To improve on the patient selection process, we used qualitative methods to better understand the issues regarding upper extremity loss as well as upper limb transplantation from the amputee point of view. Methods: Individuals with upper limb amputations (age range = 24–73 years) discussed their adjustment following amputation and their interest toward transplantation in either a focus group (n = 5) or semi-structured interview (n = 17). Transcripts were coded by theme and summarized. Results: Participants described a year-long process typified by adjustment to a new role as an amputee, both psychosocially and functionally. We found that the extent of adjustment was inversely related to an interest in transplantation. Conclusions: These findings could explain the difficulty in identifying “ideal” candidates for upper extremity transplantation and may have implications for patient selection and counseling. Level of Evidence: Prognostic Study, Level V
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Affiliation(s)
- Simon G Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew J Carty
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Sally E Jensen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gregory A Dumanian
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Raimondo TM, Li H, Kwee BJ, Kinsley S, Budina E, Anderson EM, Doherty EJ, Talbot SG, Mooney DJ. Combined delivery of VEGF and IGF-1 promotes functional innervation in mice and improves muscle transplantation in rabbits. Biomaterials 2019; 216:119246. [PMID: 31203034 DOI: 10.1016/j.biomaterials.2019.119246] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/26/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
Microvascular muscle transfer is the gold standard for reanimation following chronic facial nerve paralysis, however, despite the regenerative capacity of peripheral motor axons, poor reinnervation often results in sub-optimal function. We hypothesized that injection of alginate hydrogels releasing growth factors directly into donor tissue would promote reinnervation, muscle regeneration, and function. A murine model of sciatic nerve ligation and neurorrhaphy was first used to assess the ability of gel delivery of vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) to promote functional reinnervation. VEGF + IGF-1 gel delivery to aged mice resulted in prolonged ability to control toe movement, increased toe spreading, and improved static sciatic index score, indicative of improved sciatic nerve and neuromuscular junction function. Further, a 26% increase in muscle fiber area, and 2.8 and 3.0-fold increases in muscle contraction force and velocity, respectively, were found compared to blank alginate in the murine model. This strategy was subsequently tested in a rabbit model of craniofacial gracilis muscle transplantation. Electromyography demonstrated a 71% increase in compound muscle action potential 9 weeks after transplantation following treatment with VEGF + IGF-1 alginate, compared to blank alginate in the rabbit model. Improving functional innervation in transplanted muscle via a hydrogel source of growth factors may enhance the therapeutic outcomes of facial palsy treatments and, more broadly, muscle transplantations.
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Affiliation(s)
- Theresa M Raimondo
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA; Wyss Institute for Biologically Inspired Engineering at Harvard University, Cambridge,MA 02138, USA
| | - Hehuan Li
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Brian J Kwee
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA; Wyss Institute for Biologically Inspired Engineering at Harvard University, Cambridge,MA 02138, USA
| | - Sarah Kinsley
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Erica Budina
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Erin M Anderson
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA; Wyss Institute for Biologically Inspired Engineering at Harvard University, Cambridge,MA 02138, USA
| | - Edward J Doherty
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Cambridge,MA 02138, USA
| | - Simon G Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA; Wyss Institute for Biologically Inspired Engineering at Harvard University, Cambridge,MA 02138, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fallahian F, Molway D, Jadeja S, Clark R, Marty FM, Riella LV, Chandraker A, Talbot SG. Eponychial lesions following bilateral upper extremity vascular composite allotransplantation: a case report. Case Reports Plast Surg Hand Surg 2018; 5:14-17. [PMID: 29441355 PMCID: PMC5804719 DOI: 10.1080/23320885.2018.1431047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
Abstract
Vascularized composite allotransplantation represents a useful addition to reconstructive options available to the plastic surgeon. Though the procedure provides beneficial functional outcomes, there remain complications, often associated with the immunosuppression necessary to maintain an allograft. We report a case of eponychial fold lesions following successful bilateral upper extremity allotransplantation.
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Affiliation(s)
- Fedra Fallahian
- School of Medicine, University of Missouri-Kansas CityKansas CityMOUSA
| | - David Molway
- Department of Medicine, Brigham and Women's HospitalBostonMAUSA
| | - Saagar Jadeja
- Department of Pathology, Brigham and Women's HospitalBostonMAUSA
| | - Rachael Clark
- Department of Dermatology, Brigham and Women's HospitalBostonMAUSA
| | | | | | - Anil Chandraker
- Department of Medicine, Brigham and Women's HospitalBostonMAUSA
| | - Simon G Talbot
- Department of Medicine, Brigham and Women's HospitalBostonMAUSA
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Abstract
PURPOSE To date, there have been over 100 upper extremity transplantations (UET) performed worldwide. However, little data are available regarding institutional screening practices or description of the population of patients that seek transplantation as a treatment modality for their upper extremity disabilities. We performed a review of our institutional experience in an attempt to better understand our referral patterns and identify factors that may be associated with successful screening. METHODS Contact demographic data, injury characteristics, and mode of referral were retrospectively reviewed from 2010 through 2015. Differences in demographic data, injury-related characteristics, and clinical trial outcomes were assessed with the Chi-square test or Fisher exact test. RESULTS There were a total of 89 UET contacts. The average age was 35.2 years, with most contacts being white (n = 24). The majority were male (n = 66; 75.0%) and the most common indication for referral was trauma (n = 43; 55.8%). Of the 89 contacts, 20 (22.5%) were physician referrals and 69 (77.5%) were self-referrals. Physician referrals led to the most screened and accepted contacts, whereas self-referrals more often led to immediate exclusion. CONCLUSIONS This study gives an overview of the demographic composition of our UET contacts, with a specific emphasis on mode of referral. We have identified that physician referrals have led to more screened and accepted patients versus self-referred individuals. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Harriet Kiwanuka
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mario A Aycart
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ericka M Bueno
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Simon G Talbot
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Rinkinen J, Molway D, Carty M, Dyer GSM, Pomahac B, Chandraker A, Talbot SG. Avascular necrosis of the humeral head following bilateral upper extremity vascular composite allotransplantation: a case report. Case Reports Plast Surg Hand Surg 2017; 4:60-64. [PMID: 28804740 PMCID: PMC5532758 DOI: 10.1080/23320885.2017.1345635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022]
Abstract
Vascularised composite allotransplantation (VCA) represents an exciting and emerging field in plastic and reconstructive surgery. Despite the generally good functional and psychosocial outcomes, multiple complications can be associated with the procedure. The authors describe a case of avascular necrosis of the humeral head following successful upper extremity VCA.
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Affiliation(s)
- Jacob Rinkinen
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - David Molway
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - Matthew Carty
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - Bohdan Pomahac
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
| | - Anil Chandraker
- Division of Transplant Surgery, Brigham and Women's HospitalBostonMAUSA
| | - Simon G Talbot
- Division of Plastic Surgery, Brigham and Women's HospitalBostonMAUSA
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Tullius SG, Pomahac B, Kim HB, Carty M, Talbot SG, Nelson HM, Delmonico FL. Successful Recovery and Transplantation of 11 Organs Including Face, Bilateral Upper Extremities, and Thoracic and Abdominal Organs From a Single Deceased Organ Donor. Transplantation 2016; 100:2226-9. [PMID: 27624820 PMCID: PMC5030114 DOI: 10.1097/tp.0000000000001200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report on the to date largest recovery of 11 organs from a single deceased donor with the transplantation of face, bilateral upper extremities, heart, 1 lung, liver (split for 2 recipients), kidneys, pancreas, and intestine. Although logistically challenging, this case demonstrates the feasibility and safety of the recovery of multiple thoracic and abdominal organs with multiple vascular composite allotransplants and tissues. Our experience of 8 additional successful multiple vascular composite allotransplants, thoracic, and abdominal organ recoveries suggests that such procedures are readily accomplishable from the same deceased donor.
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Affiliation(s)
- Stefan G. Tullius
- Division of Transplant Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Bohdan Pomahac
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Heung Bae Kim
- Pediatric Transplant Center, Children’s Hospital, Boston, MA
| | - Matthew Carty
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Simon G. Talbot
- Division of Plastic and Reconstructive Surgery, Brigham and Women’s Hospital, Boston, MA
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Singh M, Kinsley S, Huang A, Ricci JA, Clancy TE, Irani J, Goldberg J, Breen E, Bleday R, Talbot SG. Gracilis Flap Reconstruction of the Perineum: An Outcomes Analysis. J Am Coll Surg 2016; 223:602-10. [DOI: 10.1016/j.jamcollsurg.2016.06.383] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/16/2016] [Accepted: 06/23/2016] [Indexed: 11/15/2022]
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Singh M, Dugdale CM, Solomon IH, Huang A, Montgomery MW, Pomahac B, Yawetz S, Maguire JH, Talbot SG. Rapid-Growing Mycobacteria Infections in Medical Tourists: Our Experience and Literature Review. Aesthet Surg J 2016; 36:NP246-53. [PMID: 27095310 DOI: 10.1093/asj/sjw047] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND "Medical tourism" has gained popularity over the past few decades. This is particularly common with patients seeking elective cosmetic surgery in the developing world. However, the risk of severe and unusual infectious complications appears to be higher than for patients undergoing similar procedures in the United States. OBJECTIVES The authors describe their experience with atypical mycobacterial infections in cosmetic surgical patients returning to the United States postoperatively. METHODS A review of patient medical records presenting with infectious complications after cosmetic surgery between January 2010 and July 2015 was performed. Patients presenting with mycobacterial infections following cosmetic surgery were reviewed in detail. An extensive literature review was performed for rapid-growing mycobacteria (RGM) related to cosmetic procedures. RESULTS Between January 2010 and July 2015, three patients presented to our institution with culture-proven Mycobacterium abscessus at the sites of recent cosmetic surgery. All had surgery performed in the developing world. The mean age of these patients was 36 years (range, 29-44 years). There was a delay of up to 16 weeks between the initial presentation and correct diagnosis. All patients were treated with surgical drainage and combination antibiotics with complete resolution. CONCLUSIONS We present series of patients with mycobacterial infections after cosmetic surgery in the developing world. This may be related to the endemic nature of these bacteria and/or inadequate sterilization or sterile technique. Due to low domestic incidence of these infections, diagnosis may be difficult and/or delayed. Consulting physicians should have a low threshold to consider atypical etiologies in such scenarios. LEVEL OF EVIDENCE 5 Therapeutic.
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Affiliation(s)
- Mansher Singh
- From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Caitlin M Dugdale
- From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Isaac H Solomon
- From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Huang
- From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary W Montgomery
- From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bohdan Pomahac
- From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sigal Yawetz
- From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James H Maguire
- From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon G Talbot
- From the Departments of Medicine, Pathology, and Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Nyame TT, Pathak A, Talbot SG. The abbe flap for upper lip reconstruction. Eplasty 2014; 14:ic30. [PMID: 25328575 PMCID: PMC4153100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Theodore T. Nyame
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Abraham Pathak
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Simon G. Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass,Correspondence:
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Wall JB, Divito SJ, Talbot SG. Chlorhexidine gluconate-impregnated central-line dressings and necrosis in complicated skin disorder patients. J Crit Care 2014; 29:1130.e1-4. [PMID: 25035049 DOI: 10.1016/j.jcrc.2014.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/06/2014] [Accepted: 06/01/2014] [Indexed: 11/17/2022]
Abstract
Although chlorhexidine gluconate (CHG) disks have been shown to help reduce the incidence of central line-associated blood stream infections, their use can result in local skin necrosis. The effects of CHG disks on patients with complex skin pathology have not been studied. We report 6 cases of dermal necrosis associated with Biopatch (Ethicon Inc, Somerville, NJ) CHG disks in adults with complex skin pathology including those with Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, burns, and anasarca. All patients had a CHG disk placed at a central venous catheter insertion site. Age range was from 21 to 84 years. Discovery of the reaction ranged from 4 to 14 days after disk placement. Resultant skin erosions required 2 to 10 weeks to reepithelialize. Complicated skin disorder patients represent a rare subset of the critically ill who appear prone to CHG disk necrosis. Continuous contact of CHG under occlusive dressings is speculated to predispose Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, and burn patients to local chemical injury secondary to loss of the epithelial tissue barrier, decreased cohesion of the epidermal-dermal junction, and increased tissue permeability. In these patients, the risk of placing the CHG disk may present more risk than using alternative antimicrobial dressings.
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Affiliation(s)
- Jennifer B Wall
- Division of Burn, Trauma, Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Division of Dermatology, Brigham and Women's Hospital, Boston, MA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
| | - Sherrie J Divito
- Division of Burn, Trauma, Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Division of Dermatology, Brigham and Women's Hospital, Boston, MA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Simon G Talbot
- Division of Burn, Trauma, Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Division of Dermatology, Brigham and Women's Hospital, Boston, MA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
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Abstract
BACKGROUND Hand allotransplantation can restore motor, sensory and cosmetic functions to upper extremity amputees. Over 70 hand transplant operations have been performed worldwide, but there is little published regarding post-hand transplant rehabilitation. METHODS The Brigham and Women's Hospital (BWH) Hand Transplantation Team's post-hand transplant rehabilitation protocol is presented here. The protocol must be modified to address each transplant recipient's unique needs. It builds on universally used modalities of hand rehabilitation such as splinting, edema and scar management, range of motion exercises, activities of daily living training, electrical stimulation, cognitive training and strengthening. RESULTS The BWH hand transplant rehabilitation protocol consists of four phases with distinct goals, frequency, and modalities. (1) Pre-operative: functional assessments are completed and goals and expectations of transplantation are established. (2) Initial post-operative (post-operative weeks 1-2): hand protection, minimization of swelling, education, and discharge. (3) Intermediate (post-operative weeks 2-8): therapy aims to prevent and/or decrease scar adhesion, increase tensile strength, flexibility and function, and prevent joint contractures. (4) Late (from 8 weeks forward): maximization of function and strength, and transition to routine activities. The frequency of rehabilitation therapy decreases gradually from the initial to late phases. CONCLUSIONS Rehabilitation therapy after hand transplantation follows a progressive increase in activity in parallel with wound healing and nerve regeneration. Careful documentation of progress and outcomes is essential to demonstrate the utility of interventions and to optimize therapy protocols.
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Affiliation(s)
- Ericka Bueno
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Marie-Jose Benjamin
- />Department of Rehabilitation Services, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Geoffroy Sisk
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Christian E. Sampson
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Matthew Carty
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Julian J. Pribaz
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Bohdan Pomahac
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Simon G. Talbot
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
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Affiliation(s)
| | | | | | - Robert D. Howe
- School of Engineering and Applied Sciences, Harvard University
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George E, Mitsouras D, Kumamaru KK, Shah N, Smith SE, Schultz K, Deaver PM, Mullen KM, Steigner ML, Gravereaux EC, Demehri S, Bueno EM, Talbot SG, Pomahac B, Rybicki FJ. Upper extremity composite tissue allotransplantation imaging. Eplasty 2013; 13:e38. [PMID: 23943677 PMCID: PMC3716341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Upper extremity (UE) transplantation is the most commonly performed composite tissue allotransplantation worldwide. However, there is a lack of imaging standards for pre- and posttransplant evaluation. This study highlights the protocols and findings of UE allotransplantation toward standardization and implementation for clinical trials. METHODS Multimodality imaging protocols for a unilateral hand transplant candidate and a bilateral mid-forearm level UE transplant recipient include radiography, computed tomography (CT), magnetic resonance (MR) imaging, catheter angiography, and vascular ultrasonography. Pre- and posttransplant findings, including dynamic CT and MR performed for assessment of motor activity of transplanted hands, are assessed, and image quality of vessels and bones on CT and MR evaluated. RESULTS Preoperative imaging demonstrates extensive skeletal deformity and variation in vascular anatomy and vessel patency. Posttransplant images confirm bony union in anatomical alignment and patency of vascular anastomoses. Mild differences in rate of vascular enhancement and extent of vascular networks are noted between the 2 transplanted limbs. Dynamic CT and MR demonstrate a 15° to 30° range of motion at metacarpophalangeal joints and 90° to 110° at proximal interphalangeal joints of both transplanted hands at 8 months posttransplant. Image quality was slightly better for CT than for MR in the first subject, while MR was slightly better in the second subject. CONCLUSION Advanced vascular and musculoskeletal imaging play an important role in surgical planning and can provide novel posttransplantation data to monitor the success of the procedure. Implementation of more standardized protocols should enable a more comprehensive assessment to evaluate the efficacy in clinical trials.
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Affiliation(s)
| | | | | | - Nehal Shah
- bMusculoskeletal Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Stacy E. Smith
- bMusculoskeletal Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Kurt Schultz
- cToshiba Medical Research Institute, Vernon Hills, Ill
| | | | | | | | | | | | - Ericka M. Bueno
- eDivision of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Simon G. Talbot
- eDivision of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Bohdan Pomahac
- eDivision of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Frank J. Rybicki
- aApplied Imaging Science Laboratory, Department of Radiology,Correspondence:
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Affiliation(s)
| | | | | | - Robert D. Howe
- School of Engineering and Applied Sciences Harvard University
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Talbot SG, Kerstein D, Jacobs LF, Upton J. CASE REPORT Postoperative Use of the NormaTec Pneumatic Compression Device in Vascular Anomalies. Eplasty 2012; 12:e6. [PMID: 22292102 PMCID: PMC3266327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Arteriovenous malformations have a wide range of clinical presentations and an unfortunately unpredictable response to both nonsurgical and surgical intervention. The authors report on the surgical treatment of a 19-year-old man with a complex lower extremity arteriovenous malformation, previously unsuccessfully treated with numerous local sclerotherapy and interventional radiology embolization procedures leading to massive tissue necrosis and deep infection. The patient was definitively treated with wide excision of the necrotic tissue, coils, and arteriovenous malformation, but with preservation of the tibial nerve and vascular supply to the foot. Significant postoperative complications were prevented with the use of a novel dynamic compression device employing peristaltic pulse pneumatic compression.
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Affiliation(s)
- Simon G. Talbot
- aDepartment of Plastic Surgery, Children's Hospital, Boston, MA
| | | | | | - Joseph Upton
- aDepartment of Plastic Surgery, Children's Hospital, Boston, MA,Correspondence:
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Abstract
BACKGROUND Upper extremity electrical burns are a cause of major morbidity and disability in affected individuals. Anecdotally, we have noted changes in the presentation of cases to our institution. We sought to compare current data on upper extremity electrical burns in children with our previously published historical data. METHODS Using the Shriners Hospital Boston and American Burn Association databases, we retrospectively analyzed electrical upper extremity burns in patients aged 21 years or younger. Data regarding demographics, etiology, and reconstruction were collated and analyzed. RESULTS In our institutional cohort, patients were most commonly males (37/48, 77%) aged 10-15 years (19/48, 40%). We have seen a rise in the proportion of female, younger patients, with burns attributed to domestic wiring, indicative of a reduction in the number of high-voltage injuries in males due to demonstrations of bravado. High-voltage injuries correlate with severity of injury and tended to be transferred to our institution from foreign countries (9/48, 19%). We have also seen a reduction in the need to amputate extremities. CONCLUSIONS Changes in upper extremity electrical burn demographics and etiology since the 1970s may be indicative of effective education and safety campaigns. Consequently, reconstructive requirements have also changed. We hope that similar ongoing efforts in the developing world may bring about comparable positive results.
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Affiliation(s)
- Simon G. Talbot
- Division of Plastic Surgery, Shriners Hospital Boston, 51 Blossom Street, Boston, MA 02114 USA
| | - Joseph Upton
- Division of Plastic Surgery, Shriners Hospital Boston, 51 Blossom Street, Boston, MA 02114 USA
| | - Daniel N. Driscoll
- Division of Plastic Surgery, Shriners Hospital Boston, 51 Blossom Street, Boston, MA 02114 USA
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Talbot SG, Davidson MJ, Javid S, Patel AN, Fitzgerald D, Patel V. Hypothermic cardiac arrest rescued with cardiopulmonary bypass and decompressive laparotomy. Emerg Med J 2010; 27:958-9. [PMID: 21036798 DOI: 10.1136/emj.2009.078865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hypothermic cardiac arrest is a relatively uncommon presentation to United States Emergency Departments. During 1979-2002, the Centers for Disease Control reported that an average of 689 deaths per year in the US were attributed to exposure to excessive natural cold. Severe hypothermia (<30°C) confers marked depression of critical metabolic and biochemical functions, but may also provide protection to the brain and other organs while resuscitation is undertaken. For all hypothermic patients, measures designed to prevent further heat loss and begin rewarming should be instituted, but should not delay routine Advanced Cardiac and Trauma Life Support procedures. Rewarming methods include passive rewarming (insulation, removal from environment), active external rewarming (heating blankets, radiant heat, warm water immersion), and active core rewarming (warm inhalation, warmed intravenous fluids, gastrointestinal irrigation, bladder irrigation, dialysis, thoracostomy lavage, and cardiopulmonary bypass).
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Affiliation(s)
- Simon G Talbot
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Abstract
Wound coverage with pedicled (local, regional, or distant) or free flaps is commonplace throughout plastic surgery. However, irrespective of the method of tissue transfer or type of tissue being transferred, inflow and outflow remain key parameters for success. Much has been written detailing complex tissue transfers and delineating arterial and venous anatomy. Despite this, simple venous insufficiency causing venous congestion is common. In experimental models, when arterial inflow is impaired, even mild venous inadequacy affects flap survival. Furthermore, studies have shown that venous congestion is more detrimental to the rate and percentage of flap area surviving than arterial ischemia. Obviously, complete venous occlusion typically requires operative exploration and correction, but many instances occur when venous congestion occurs for reasons other than complete venous thrombosis. Here we detail the basic postoperative "first aid" techniques available to optimize venous drainage. Although these techniques are not a substitute for sound anatomic flap selection, good surgical technique, or re-operation when a significant underlying problem exists, they do offer additional options to improve flap outcomes.
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Affiliation(s)
- Simon G Talbot
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Abstract
Reconstruction of defects or wounds of the distal third of the leg with exposed bone, tendon, or hardware is challenging. Free tissue transfer has allowed limb salvage in many cases but requires a relatively healthy and stable patient, long operative times, and a significant expense. Small and moderate-size wounds of the distal leg may be better served by the use of local and regional flaps. Due to a better understanding of leg vascular anatomy and angiosomes, as well as more sophisticated and varied flap designs, local and regional flaps have been described and successfully used in distal leg wounds. The goal is choosing the most appropriate flap given the patient's anatomy and wound characteristics. The following review will detail the available local and regional flaps for reconstruction of the distal third of the leg with an emphasis on decision making, anatomy, flap design, and technique.
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Affiliation(s)
- Brian M Parrett
- Division of Plastic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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O-charoenrat P, Sarkaria I, Talbot SG, Reddy P, Dao S, Ngai I, Shaha A, Kraus D, Shah J, Rusch V, Ramanathan Y, Singh B. SCCRO (DCUN1D1) induces extracellular matrix invasion by activating matrix metalloproteinase 2. Clin Cancer Res 2008; 14:6780-9. [PMID: 18980971 DOI: 10.1158/1078-0432.ccr-08-0719] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Ectopic expression of squamous cell carcinoma-related oncogene (SCCRO or DCUN1D1) in NIH-3T3 cells induces invasion in vitro and produces highly invasive xenografts in nude mice with a propensity for regional lymphatical metastasis. The aim of this study was to identify the molecular mechanism underlying SCCRO-induced invasion and metastasis. EXPERIMENTAL DESIGN The molecular mechanism of SCCRO-mediated effects on matrix metalloproteinase-2 (MMP2) levels and activity were assessed using a combination of cell biological and molecular methods, including real-time PCR, reporter assay, RNA interference, and chromatin immunoprecipitation assay. Tumor specimens from primary upper aerodigestive tract carcinomas (n = 89) were examined for levels of SCCRO, MMP2, MMP9, MT1-MMP, TIMP1, and TIMP2 mRNA by real-time PCR. RESULTS Overexpression of SCCRO increases MMP2 levels and activity, which is required for SCCRO-induced invasion. Modified McKay assays reveal that SCCRO does not bind to the MMP2 promoter, suggesting that its transcriptional effects are indirect. Deletion or mutation of the activator protein-2 (AP2) and p53 binding element within the MMP2 promoter abrogates SCCRO-driven activation. Ectopic expression of SCCRO increases AP2 levels and promotes the binding of p53 to the MMP2 promoter. Consistent with these findings, SCCRO and MMP2 are coexpressed (P<0.0001; r(2)=0.58; 95% confidence interval, 0.46-0.69) in primary (upper aerodigestive tract) carcinomas (n=89), and this coexpression is associated with an increased prevalence of regional nodal metastasis (P=0.04; relative risk, 1.53). CONCLUSIONS SCCRO-induced invasion involves activation of MMP2 transcription in an AP2- and p53-dependent manner. SCCRO is a potential marker for metastatic progression in affected cancers.
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Affiliation(s)
- Pornchai O-charoenrat
- The Laboratory of Epithelial Cancer Biology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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Xiao J, Chen X, Zhang L, Talbot SG, Li GC, Xu M. Investigation of the Mechanism of Enhanced Effect of EGCG on Huperzine Aʼs Inhibition of Acetylcholinesterase Activity in Rats by a Multispectroscopic Method. J Agric Food Chem 2008; 56:910-5. [PMID: 18193834 DOI: 10.1021/jf073036k] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Wen J, Wang XC, Zhang YW, Nie YL, Talbot SG, Li GC, Xiao JB, Xu M. Mitogen-activated Protein Kinase Inhibitors Induce Apoptosis and Enhance the Diallyl Disulfide-induced Apoptotic Effect in Human CNE2 Cells. ACTA ACUST UNITED AC 2008. [DOI: 10.1248/jhs.54.129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jun Wen
- Research Institute for Molecular Pharmacology and Therapeutics, Central South University
| | - Xiao Chun Wang
- Department of Medical Laboratories, Xiangya Medical College of Central-South University
| | - Yi Wei Zhang
- Research Institute for Molecular Pharmacology and Therapeutics, Central South University
| | - Ya Li Nie
- Research Institute for Molecular Pharmacology and Therapeutics, Central South University
| | - Simon G. Talbot
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center
| | - Gloria C. Li
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center
| | - Jian Bo Xiao
- Research Institute for Molecular Pharmacology and Therapeutics, Central South University
| | - Ming Xu
- Research Institute for Molecular Pharmacology and Therapeutics, Central South University
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center
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