Full face transplant: the first case report.

BACKGROUND: Since 2005, 11 human face transplants have been performed. In each, varying amounts of tissue have been transplanted. Herein we report a "full" face transplant including all intact aesthetic and functional units. METHODS: On March 27, 2010, we performed a full face transplant, including all the soft tissues and part of the underlaying bony structure, at the University Hospital Vall d'Hebron, Barcelona, Spain. The donor was a 41-year-old male, who died from a massive brain hemorrhage. The recipient was a 30-year-old male with a severe facial deformity caused by a ballistic trauma in 2005. Harvest and subsequent implant took 24 hours. The patient received initial induction (Thymoglobulin 2 mg/kg/iv; Prednisone 1 gm/iv) and maintenance (Prednisone 1 mg/kg/24hours, Tacrolimus 10-15 ng/mL/PO, and Mycophenolate mofetil 2g/daily/PO) immunosuppression and Infection prophylaxis (Valganciclovir and Co-trimoxazole). RESULTS: There were no intraoperative complications. Postoperative complications included; venous anastomoses thrombosis, acute oro-cutaneous fistula, right parotid sialocele and 2 acute rejection episodes, which were resolved by revision of the anastomosis, profuse irrigation and immunotherapy adjustment, respectively. The patient was discharged from the hospital at 4 months posttransplant with; near-total sensation and partial-motor recovery, no psychological complications and excellent acceptance of his new facial appearance. CONCLUSIONS: The early success described in this case report demonstrates the technical and clinical feasibility of transplanting all the tissues of the with all its aesthetic and functional units intact.

Effect of radiologist experience on the risk of false-positive results in breast cancer screening programs.

OBJECTIVES: To evaluate the effect of radiologist experience on the risk of false-positive results in population-based breast cancer screening programmes. METHODS: We evaluated 1,440,384 single-read screening mammograms, corresponding to 471,112 women aged 45-69 years participating in four Spanish programmes between 1990 and 2006. The mammograms were interpreted by 72 radiologists. RESULTS: The overall percentage of false-positive results was 5.85% and that for false-positives resulting in an invasive procedure was 0.38%. Both the risk of false-positives overall and of false-positives leading to an invasive procedure significantly decreased (p < 0.001) with greater reading volume in the previous year: OR 0.77 and OR 0.78, respectively, for a reading volume 500-1,999 mammograms and OR 0.59 and OR 0.60 for a reading volume of >14,999 mammograms with respect to the reference category (<500). The risk of both categories of false-positives was also significantly reduced (p < 0.001) as radiologists' years of experience increased: OR 0.96 and OR 0.84, respectively, for 1 year's experience and OR 0.72 and OR 0.73, respectively, for more than 4 years' experience with regard to the category of <1 year's experience. CONCLUSION: Radiologist experience is a determining factor in the risk of a false-positive result in breast cancer screening.

Severely damaged lower limb salvage in a critically ill burned patient. Lessons learned.

Lower limb salvage in severely injured burned patients with bone or tendon exposure may be a reconstructive challenge. In this cases, local or regional flaps and other more conservative therapies such as dermal substitutes and negative-pressure wound therapy are usually not available or are not good enough to solve the problem. In such situations, microsurgical reconstruction with distant flaps seems to be the best option, even though the particularities of the severe burn patient may decrease free flaps' success rate. We report the case of a patient with severe electrical injuries affecting 70% of the total body surface area who had full-thickness burns to the lower extremity with wide bone exposure and extensively drug-resistant Pseudomonas aeruginosa infection. We achieved limb salvation using rectus femoris muscle free flap plus lateral and medial gastrocnemius muscle flaps and soleus muscle flap, after two failed microsurgical coverture attempts and a long not useful periplus with conservative therapies such us negative-pressure wound therapy and dermal substitutes. After 3 years of follow-up, the patient can walk without aid, and he has recovered his social and employment situation prior to the accident.