A Systematic Review of the Reported Complications Related to Facial and Upper Extremity Vascularized Composite Allotransplantation

Milek, David; Reed, Laura T.; Echternacht, Scott R.; Shanmugarajah, Kumaran; Cetrulo, Curtis L.; Lellouch, Alexandre G.; Langstein, Howard N.; Leckenby, Jonathan I.

doi:10.1016/j.jss.2022.08.023

Cited by 23 publications

(24 citation statements)

References 95 publications

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“…Mounting body of evidence points toward CD8 + effector T cells as the hallmark effectors of VCA rejection targeting epidermal and follicular stem cells (and to a lesser extent the microvascular endothelium), thus driving acute cellular rejection reactions ( 16 , 23 , 24 ). Besides these key effector-target cell interactions, multiple secondary effectors, in addition to other cellular targets, are involved in VCA rejection ( 17 ).…”

Section: The Hierarchy Of Effector-target Cell Interactions: Cells An...mentioning

confidence: 99%

Cellular activation pathways and interaction networks in vascularized composite allotransplantation

Knoedler

Lee

et al. 2023

Front. Immunol.

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Vascularized composite allotransplantation (VCA) is an evolving field of reconstructive surgery that has revolutionized the treatment of patients with devastating injuries, including those with limb losses or facial disfigurement. The transplanted units are typically comprised of different tissue types, including skin, mucosa, blood and lymphatic vasculature, muscle, and bone. It is widely accepted that the antigenicity of some VCA components, such as skin, is particularly potent in eliciting a strong recipient rejection response following transplantation. The fine line between tolerance and rejection of the graft is orchestrated by different cell types, including both donor and recipient-derived lymphocytes, macrophages, and other immune and donor-derived tissue cells (e.g., endothelium). Here, we delineate the role of different cell and tissue types during VCA rejection. Rejection of VCA grafts and the necessity of life-long multidrug immunosuppression remains one of the major challenges in this field. This review sheds light on recent developments in decoding the cellular signature of graft rejection in VCA and how these may, ultimately, influence the clinical management of VCA patients by way of novel therapies that target specific cellular processes.

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Section: The Hierarchy Of Effector-target Cell Interactions: Cells An...mentioning

confidence: 99%

Cellular activation pathways and interaction networks in vascularized composite allotransplantation

Knoedler

Lee

et al. 2023

Front. Immunol.

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“…WR b (n=7) NU a (n=7) Total Characteristics 0 (0) 3 (43) 3 (21) Good 1 ( 14) 0 (0) 1 (7) Fair Dominant hand amputated, n (%) 5 7) 0 (0) 5 ( 36) 8 (57) The words, phrases, and expressions are familiar to the intended audience. 0 (0) 0 (0) 1 ( 7) 5 (36) 8 (57) The words, phrases, and expressions are free from stereotypical meaning.…”

Section: Asq Resultsmentioning

confidence: 99%

“…Although UE VCA aims to and can potentially restore motor function and sensation and improve quality of life, this treatment poses risks, including lifelong immunosuppression, rejection, and long-term rehabilitation [3,4]. Episodes of acute rejection are common in VCA, and most VCA recipients experience rejection episodes; rates are higher in VCA than in solid organ transplants [5][6][7]. The function regained after UE VCA differs for each recipient.…”

Section: Introductionmentioning

confidence: 99%

A Patient-Centered Website (Within Reach) to Foster Informed Decision-making About Upper Extremity Vascularized Composite Allotransplantation: Development and Usability Study

Vanterpool¹,

Gacki-Smith²,

Kuramitsu³

et al. 2023

JMIR Form Res

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Background Upper extremity (UE) vascularized composite allotransplantation (VCA; hand transplantation) is a reconstructive treatment option for patients with UE loss. Approximately 37 UE VCAs have been performed in the United States to date; thus, little is known about long-term psychosocial outcomes and whether the benefits outweigh the risks. To make an informed treatment decision, patients must understand the procedure, risks, and potential benefits of UE VCA. However, few educational resources are publicly available providing unbiased, comprehensive information about UE VCA. Objective This paper described the development of a neutral, and accessible, educational website supporting informed decision-making about UE VCA as a treatment option for individuals with UE amputations. Methods Website content development was informed by 9 focus groups conducted with individuals with UE amputations at 3 study sites. After initial website development, we conducted usability testing to identify ways to improve navigability, design, content, comprehension, and cultural sensitivity. Participants were administered the After-Scenario Questionnaire to assess user performance after completing navigational tasks, System Usability Scale to measure the perceived usability of the website, and Net Promoter Score to measure user satisfaction. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using rapid thematic analysis. Results A total of 44 individuals with UE amputations participated in focus groups (n=37, 84%) and usability testing (n=14, 32%). Most participants in the focus groups and usability testing were male (24/37, 65% and 11/14, 79%, respectively) and White (27/37, 73% and 9/14, 64%, respectively), had unilateral limb loss (22/37, 59% and 12/14, 86%, respectively), and had mean ages of 48 (SD 9.2) and 50 (SD 12.0) years, respectively. Focus group results are organized into accessibility, website design, website development, website tone and values, sitemap, terminology, images and videos, and tables and graphics. Usability testing revealed that participants had a positive impression of the website. The mean After-Scenario Questionnaire score of 1.3 to 2.3 across task scenarios indicated high satisfaction with website usability, the mean System Usability Scale score of 88.9 indicated user satisfaction with website usability, and the mean Net Promoter Score of 9.6 indicated that users were enthusiastic and would likely refer individuals to the website. Conclusions The findings suggest that our educational website, Within Reach, provides neutral, patient-centered information and may be a useful resource about UE VCA for individuals with UE amputations, their families, and health care professionals. Health care professionals may inform UE VCA candidates about Within Reach to supplement current VCA education processes. Within Reach serves as a resource about treatment options for patients preparing for scheduled or recovering from traumatic UE amputations. Future research should assess whether Within Reach improves knowledge about UE VCA and enhances informed decision-making about UE VCA as a treatment option.

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“…The evaluation of children as potential candidates for VCA for facial reconstruction has already been commented by many leaders in VCA, psychologists and psychiatrists, ethicists, and researchers. There are many barriers precluding inclusion of pediatric patients as potential candidates: the difficulty of establishing at which age a child might be aware of the procedure implications, parents' right to give consent, psychological issues and whether VCA is worth the tradeoff for a better, but shorter life as they would face the complications associated with life-long immunosuppression ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Pediatric alloplastic nose reconstruction with a 3D printed patient specific titanium implant

Ureel,

Dadjam,

Dhooghe

et al. 2024

Front. Surg.

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An 11-year-old girl presented at the emergency service with a nasal defect caused by a dog bite in the midface. Autologous nose reconstruction in the pediatric population is challenging due to donor site morbidity and remaining facial growth. Temporary prosthetic treatment is difficult to accept due to problems with retention. We present an innovative solution using a 3D printed patient specific titanium implant for support of a nasal prosthesis. With preoperative 3-dimensional planning, the implant can be designed to find fixation in the areas with the best bone quality, avoid potential damage to tooth buds and dental roots and avoid interference to soft tissues such as the nasal septum. Clear communication between the anaplastologist, surgeon and medical engineer is crucial for treatment success. The impact of facial growth is still unclear and will have to be assessed.

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A Systematic Review of the Reported Complications Related to Facial and Upper Extremity Vascularized Composite Allotransplantation

Cited by 23 publications

References 95 publications

Cellular activation pathways and interaction networks in vascularized composite allotransplantation

Cellular activation pathways and interaction networks in vascularized composite allotransplantation

A Patient-Centered Website (Within Reach) to Foster Informed Decision-making About Upper Extremity Vascularized Composite Allotransplantation: Development and Usability Study

Case Report: Pediatric alloplastic nose reconstruction with a 3D printed patient specific titanium implant

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