Concomitant Face and Upper Extremity Transplantation
From its first origination involving successful rat hind limb allograft studies using cyclosporine, face and upper extremity transplantation (CTA) has since developed into an exciting and promising subset of reconstructive transplant surgery. Current surgical technique involving CTA has allowed optimal outcomes in patients with massive facial and/or upper extremity defects, however, with its coexisting immunological barrier; obligatory lifelong immunosuppression commits each patient to a daily risk of transplant-related complications with many unanswered questions. Since 1998, nearly 50 hands in 40 patients have been performed around the world at various levels ranging from wrist to shoulder. However, the risk-to-benefit ratio remains controversial in bilateral versus unilateral transplantation and has yet to be answered. A total of ten face transplants have been performed since 2005. Concomitant CTA, 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 manner for reconstruction.
KeywordsCortical Reorganization Bilateral Hand Face Transplantation Acute Normovolemic Hemodilution Hand Transplant
Composite tissue allotransplantation
Intensive care unit
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