Research progress of allogeneic abdominal wall transplantation / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress of surgical technique and immunosuppressive regimen of abdominal wall vascularized composite allograft transplantation in animals and clinical practice.@*METHODS@#The literature on abdominal wall transplantation at home and abroad in recent years was extensively reviewed and analyzed.@*RESULTS@#This review includes animal and clinical studies. In animal studies, partial or total full-thickness abdominal wall transplantation models have been successfully established by researchers. Also, the use of thoracolumbar nerves has been described as an important method for functional reconstruction and prevention of long-term muscle atrophy in allogeneic abdominal wall transplantation. In clinical studies, researchers have utilized four revascularization techniques to perform abdominal wall transplantation, which has a high survival rate and a low incidence of complications.@*CONCLUSION@#Abdominal wall allotransplantation is a critical reconstructive option for the difficulty closure of complex abdominal wall defects. Realizing the recanalization of the nerve in transplanted abdominal wall to the recipient is very important for the functional recovery of the allograft. The developments of similar research are beneficial for the progress of abdominal wall allotransplantation.

Análises macroscópica e histopatológica do alotransplante parcial de vesícula urinária com células-tronco mesenquimais alogênicas derivadas do tecido adiposo em coelhos / Macroscopic and histopathological analysis of partial urinary bladder allograft using allogenic adipose tissue derived mesenchymal stem cells in rabbits

O número de transplantes de órgãos e tecidos em humanos e animais tem crescido significativamente nos últimos anos, principalmente após o advento de técnicas modernas e mais seguras indutoras de imunossupressão. Objetiva-se com o presente estudo avaliar macro e microscopicamente o alotransplante parcial de bexiga a fresco em coelhos, utilizando como agente imunomodulador células-tronco mesenquimais derivadas do tecido adiposo (ADSC) alogênicas. Foram utilizados 25 coelhos, sendo um deles macho e doador das ADSCs, e os outros 24 eram fêmeas, submetidas a alotransplante parcial de bexiga, tratadas com ciclosporina (GCi) ou células-tronco mesenquimais (GCe). Conclui-se que o GCe teve melhor aceitação histológica do implante em relação ao GCi aos 30 dias de avaliação.(AU)

The number of organ and tissue transplantation in humans and animals has grown significantly recently, especially after the advent of modern and safer techniques of immunosuppression. The objective of this study was to evaluate macro and microscopically partial urinary bladder fresh allograft in rabbits, using as immunomodulatory agent cyclosporine or allogenic adipose tissue derived mesenchymal stem cells (ADSCs). For this purpose, 25 rabbits were used. One male was the donor of ADSCs; 24 females received a partial urinary bladder allograft and were treated with cyclosporine (GCi) or mesenchymal stem cells (GCe). We conclude that the GCe group had better histological acceptance of the implant than GCi group at 30 days evaluation.(AU)

Anesthetic management of the first forearm transplantation in Korea / 대한마취과학회지

Vascularized composite allotransplantation for the forearm is a complex surgical procedure, requiring multidisciplinary collaboration. It is important to provide optimal blood flow to the grafts, effective immunosuppression, and early rehabilitation for graft survival and good functional outcomes. As ischemia-reperfusion injury and substantial but unquantifiable blood loss are inevitable in this type of surgery, anesthetic management should focus on providing adequate hemodynamic management with proper monitoring, and anesthetic and analgesic strategies to prevent vasoconstriction in the graft. In this paper, we describe the anesthetic management of the first forearm transplantation performed in Korea.

Risk Acceptance and Expectations of Scalp Allotransplantation

BACKGROUND: In scalp allotransplantation, the scalp from a brain-dead donor, including hair, is transferred to a recipient with scalp defects. Opinions differ on the appropriateness of scalp allotransplantation. In order to maintain graft function and cosmetic outcomes, scalp transplantation recipients would need to receive lifelong immunosuppression treatments. The risks of this immunosuppression have to be balanced against the fact that receiving a scalp allotransplant does not extend lifespan or restore a physical function. Therefore, the present study aimed to investigate risk acceptance and expectations regarding scalp allotransplantation in different populations. METHODS: A questionnaire survey study was conducted. A total of 300 subjects participated; survey was conducted amongst the general public (n=100), kidney transplantation recipients (n=50), a group of patient who required scalp reconstruction due to tumor or trauma (n=50), and physicians (n=100). The survey was modified by using the Korean version of the Louisville instrument for transplantation questionnaire. RESULTS: Risk acceptance and expectations for scalp transplantation varied widely across the groups. Kidney transplantation recipients revealed the highest risk acceptance and expectations, whereas the physicians were most resistant to the risks of scalp transplantation. CONCLUSION: Our study demonstrates that, in specific groups, scalp allotransplantation and the need for immunosuppression carries an acceptable risk despite the lack of lifeextending benefits. Our results suggest that scalp allotransplantation can be an acceptable alternative to existing scalp reconstruction surgeries in patients with pre-existing need for immunosuppression.

Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection / 한국유방암학회지

Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation.

Inducción de tolerancia en modelo de autotrasplante / Induction of tolerance in allogeneic transplant model

Introduction: Vascularized composite allotransplantation (VCA) involves the transplantation of complex anatomical structures including different kinds of tissue. The aim was to study the effect of a treatment with immature dendritic cells in a model of VCA. Materials and Methods: The rat hind limb allotransplantation model was used. Due to the high antigenic mistmatch Brown Norway rats were used as donors and Lewis rats as recipients. The bone marrow derived immature dendritic cells were cultured under GM-CSF stimuli and donor tissue. The rejection grade and the survival of the graft were assessed. Experimental groups: group I (n = 3): no treatment; Group II (n = 6): tacrolimus 10 mg/kg one day before the transplantation (day -1); Group III (n = 3): tacrolimus 10 mg/kg on day -1 and 6 mg/kg from day 0 to 14, plus intravenous saline infusion on days 7 and 14; Group IV (n = 3): tacrolimus 10 mg/kg on day -1 and 6 mg/kg from day 0 to 14, plus intravenous immature dendritic cells on days 7 and 14. Results: All 15 allografts developed rejection. The mean allograft survival was 14 days in group I, 15 days in group II, 34 days in group III and 58 days in groups IV (p < 0.05). Conclusions: In the rat hind limb allotransplantation model under tacrolimus monotherapy, the treatment with immature bone marrow derived dendritic cells pulsed with alloantigens increases the survival of the graft.

Introducción: El alotrasplante compuesto vascularizado (ACV) involucra el trasplante de estructuras anatómicas complejas que pueden contener distintos tipos de tejidos. El objetivo de este estudio fue evaluar el efecto del tratamiento con células dendríticas inmaduras derivadas de médula ósea del receptor y cargadas con aloantígenos como potencial inductor de tolerancia en un modelo de ACV. Animales y Métodos: Para realizar el modelo de alotrasplante de extremidad posterior de la rata, se utilizaron como donantes ratas Brown Norway y como receptoras ratas Lewis. Las células dendríticas se diferenciaron a partir de precursores de médula ósea que se cargaron con lisado de tejido del donante. Grupos experimentales: Grupo I (n = 3): sin tratamiento; Grupo II (n = 6): tacrolimus 10 mg/kg vía oral el día previo al trasplante (día -1); Grupo III (n = 3): tacrolimus 10 mg/kg el día -1 y 6 mg/kg desde el día 0 al 14 post operatorio como mantención; Grupo IV (n = 3): mismo esquema de tacrolimus que grupo III, pero además infusión intravenosa de células dendríticas los días 7 y 14. Se evaluó la sobrevida de los implantes y el grado de rechazo. Resultados: Los 15 animales trasplantados presentaron rechazo. La sobrevida media del ACV fue de 14 días en el grupo I, 15 días en el grupo II, 34 días en el grupo III y 58 días en el grupo IV (p < 0,05). Conclusión: En un modelo de ACV bajo tratamiento con tacrolimus, la infusión de células dendríticas inmaduras derivadas de médula ósea y pulsadas con aloantígeno aumentan la sobrevida del implante.

Alotransplante de pele como alternativa para o tratamento da queimadura dolorosa da criança / Allograft skin as an alternative for the treatment of the painful burn in children

Queimaduras de segundo grau são especialmente dolorosas em crianças. A cada dia que passa, a pele queimada tende a cicatrizar, mas há momentos em que a área lesada fica pior devido a curativos inadequados ou à infecção. A utilização de substitutivos dérmicos deve ser considerada. Relatamos a utilização de aloenxerto de pele como um substitutivo dérmico transitório, a fim de diminuir a dor e promover a reepitelização em queimaduras dolorosas de segundo grau. A redução da dor foi completa após o uso do aloenxerto de pele. A criança obteve reepitelização completa da área lesada, não necessitando de internação e enxerto autólogo. Aloenxertos podem representar uma possibilidade de cobertura temporária para queimaduras dolorosas de segundo grau em crianças.

Second-degree burns are especially painful in children. With each passing day, the burned skin tends to heal, but there are times when the injured area gets worst due to inadequate dressing or infection. The use of dermal substitutes must be considered. We report the use of skin allograft as a transitory dermal substitute in order to decrease pain and promote re-epithelialization in painful second-degree burns. The child got complete re-epithelialization of the injured area, not requiring hospitalization and skin grafts. The pain reduction was complete after using skin allograft. Allografts may represent a possibility of temporary coverage in painful second-degree burns in children.

Hemifacial Transplantation Model in Rats

BACKGROUND: To refine facial transplantation techniques and achieve sound results, it is essential to develop a suitable animal model. Rat is a small animal and has many advantages over other animals that have been used as transplantation models. The purpose of this study was to describe a rat hemifacial transplantation model and to verify its convenience and reproducibility. METHODS: Animals used in this study were Lewis rats (recipients) and Lewis-Brown Norway rats (donors). Nine transplantations were performed, requiring 18 animals. The hemifacial flap that included the ipsilateral ear was harvested based on the unilateral common carotid artery and external jugular vein and was transferred as a single unit. Cyclosporine A therapy was initiated 24 hours after transplantation and lasted for 2 weeks. Signs of rejection responses were evaluated daily. RESULTS: The mean transplantation time was 1 hour 20 minutes. The anatomy of common carotid artery and external jugular vein was consistent, and the vessel size was appropriate for anastomosis. Six of nine allografts remained good viable without vascular problems at the conclusion of study (postoperative 2 weeks). CONCLUSION: The rat hemifacial transplantation model is suitable as a standard transplantation training model.

Hemifacial Transplantation Model in Rats

BACKGROUND: To refine facial transplantation techniques and achieve sound results, it is essential to develop a suitable animal model. Rat is a small animal and has many advantages over other animals that have been used as transplantation models. The purpose of this study was to describe a rat hemifacial transplantation model and to verify its convenience and reproducibility. METHODS: Animals used in this study were Lewis rats (recipients) and Lewis-Brown Norway rats (donors). Nine transplantations were performed, requiring 18 animals. The hemifacial flap that included the ipsilateral ear was harvested based on the unilateral common carotid artery and external jugular vein and was transferred as a single unit. Cyclosporine A therapy was initiated 24 hours after transplantation and lasted for 2 weeks. Signs of rejection responses were evaluated daily. RESULTS: The mean transplantation time was 1 hour 20 minutes. The anatomy of common carotid artery and external jugular vein was consistent, and the vessel size was appropriate for anastomosis. Six of nine allografts remained good viable without vascular problems at the conclusion of study (postoperative 2 weeks). CONCLUSION: The rat hemifacial transplantation model is suitable as a standard transplantation training model.