Face, Upper Extremity, and Concomitant Transplantation: Potential Concerns and Challenges Ahead
- 1 July 2010
- journal article
- review article
- Published by Wolters Kluwer Health in Plastic and Reconstructive Surgery
- Vol. 126 (1), 308-315
- https://doi.org/10.1097/prs.0b013e3181dcb6f4
Abstract
From its origination involving successful rat hind-limb allograft studies using cyclosporine, face and upper extremity composite tissue allotransplantation has since developed into an exciting and promising subset of reconstructive transplant surgery. Current surgical technique involving composite tissue allotransplantation has allowed optimal outcomes in patients with massive facial and/or upper extremity defects; however, with its coexisting immunologic barrier, obligatory lifelong immunosuppression commits each patient to a daily risk of transplant-related complications with many unanswered questions. Since 1998, nearly 50 hand transplantations in 40 patients have been performed around the world at various levels ranging from wrist level to shoulder level. However, the risk-to-benefit ratio remains controversial in bilateral versus unilateral transplantation and has yet to be determined. From recent experience, the two most important determinants of the success of each patient's upper extremity transplant are patient compliance and intense rehabilitation. A total of nine face transplants have been performed since 2005. Multiple aesthetic subunits (i.e., nose, lips, eyelids) with or without underlying craniofacial skeletal defects (i.e., maxilla, mandible) have been successfully restored, thereby providing restoration of vital facial functions (i.e., smiling) in an unprecedented manner. As of today, face transplantation carries an estimated 2-year mortality of 20 percent. Concomitant composite tissue allotransplantation, which involves a variable combination of allograft subtypes, has been performed in two of the nine face transplant patients. These have included simultaneous bilateral hand transplants and tongue with mandible. Future study is warranted to investigate the potential advantages and disadvantages of using this approach versus a staged approach for reconstruction.This publication has 33 references indexed in Scilit:
- Mesenchymal Stem Cells Prolong Composite Tissue Allotransplant Survival in a Swine ModelTransplantation, 2009
- An Anatomical Study of External Carotid Artery Vascular Territories in Face and Midface Flaps for TransplantationPlastic and Reconstructive Surgery, 2009
- Facial Subunit Composite Tissue Allografts in Nonhuman Primates: I. Technical and Immunosuppressive Requirements for Prolonged Graft SurvivalPlastic and Reconstructive Surgery, 2009
- Establishing a New Orthotopic Composite Hemiface/Calvaria Transplantation Model in RabbitsPlastic and Reconstructive Surgery, 2008
- Developing a Canine Model of Composite Facial/Scalp Allograft TransplantationAnnals of Plastic Surgery, 2007
- Technical and Anatomical Considerations of Face Harvest in Face TransplantationAnnals of Plastic Surgery, 2006
- From experimental rat hindlimb to clinical face composite tissue allotransplantation: Historical background and current statusMicrosurgery, 2006
- Composite Tissue Allotransplantation: Development of a Preclinical Model in Nonhuman PrimatesTransplantation, 2005
- A New Composite Facial and Scalp Transplantation Model in RatsPlastic and Reconstructive Surgery, 2003
- Functional tolerance following face transplantation in the ratTransplantation, 2003