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Full Stride pp 195–212Cite as

Lower Extremity Transplantation: Concepts, Challenges, and Controversies

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Abstract

Reconstructive transplantation with vascularized composite allografts is an emerging frontier, with more than 200 procedures performed worldwide over the past decade. Lower extremity transplantation may be a superior treatment alternative in stringently selected patients who have failed, rejected, or are ineligible to use conventional prosthetics. Despite its potential for sensorimotor nerve regeneration, proprioception, and reflex feedback control of balance and independent ambulation, early outcomes of lower extremity transplantation have been disappointing due to morbidity or mortality. Broader feasibility of this promising procedure will be realized only if perioperative and immunosuppressive complications are minimized and long-distance neurodegeneration is optimized.

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Abbreviations

ATG:

Antithymocyte globulin

BMI:

Body mass index

BTFA:

Bilateral transfemoral amputations

CD:

Cluster of differentiation

CMV:

Cytomegalovirus

CNS:

Central nervous system

DCBI:

Dismounted complex blast injury

EBV:

Epstein-Barr virus

GU:

Genitourinary

GWOT:

Global war on terror

HLA:

Human leukocyte antigen

IED:

Improvised explosive device

IgG:

Immunoglobulin G

IRI:

Ischemia reperfusion injury

LET:

Lower extremity transplantation

MAST:

Military antishock trousers

NMJ:

Neuromuscular junction

OEF:

Operation enduring freedom

OIF:

Operation Iraqi freedom

OPTN:

Organ procurement and transplantation network

PASG:

Pneumatic antishock garments

PTLD:

Posttransplant lymphoproliferative disease

RT:

Reconstructive transplantation

TF:

Transfemoral

UNOS:

United Network for Organ Sharing

VCA:

Vascularized composite allotrans-plantation

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The views expressed in this presentation are those of the author(s) and do not reflect the official policy or position of the US Army, the Department of Defense, or the US Government.

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Authors and Affiliations

  1. Reconstructive Transplantation Program, Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Vijay S. Gorantla MD, PhD, FRCS

  2. Department of Plastic, Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey

    Fatih Zor MD

  3. Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University, Ankara, Turkey

    Serdar Nasir MD

  4. Division of Reconstructive and Plastic Surgery, University of Arizona, Tucson, AZ, USA

    Warren C. Breidenbach MD, FRCS (C)

  5. United States Army Institute for Surgical Research, San Antonio Military Medical Center, San Antonio, TX, USA

    Michael R. Davis MD, FACS

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  1. Vijay S. Gorantla MD, PhD, FRCS
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  2. Fatih Zor MD
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  3. Serdar Nasir MD
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  4. Warren C. Breidenbach MD, FRCS (C)
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  5. Michael R. Davis MD, FACS
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Correspondence to Vijay S. Gorantla MD, PhD, FRCS .

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Editors and Affiliations

  1. The Geneva Foundation, Tacoma, Washington, USA

    Victoria Tepe

  2. Syracuse University, Syracuse, New York, USA

    Charles M. Peterson

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Gorantla, V.S., Zor, F., Nasir, S., Breidenbach, W.C., Davis, M.R. (2017). Lower Extremity Transplantation: Concepts, Challenges, and Controversies. In: Tepe, V., Peterson, C. (eds) Full Stride. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7247-0_11

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