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Mackiewicz-Nartowicz H, Nawrocka L, Burduk P, Sinkiewicz A. Voice Rehabilitation After Laryngeal Transplantation: Own Experience. J Voice 2024:S0892-1997(24)00021-3. [PMID: 38443266 DOI: 10.1016/j.jvoice.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND PURPOSE Laryngeal transplantation (LT) remains an infrequently performed procedure due to well-defined and limited medical indications. The challenges include a very complicated surgery, continuous immunosuppressive treatment, as well as post-transplant rehabilitation of voice, speech, and swallowing. The aim of this paper is to describe a model of voice and speech rehabilitation after LT, based on our own experience. STUDY DESIGN Observational study. METHOD Presented here are the rehabilitation processes of two patients who had previously undergone LT as well as their pre- and postrehabilitation voice outcomes. Both patients underwent voice, speech, and swallowing rehabilitation in the fifth month after LT. RESULTS One of the patients had a significant improvement in voice quality. While, the other did not regain his natural, sonorous voice, but he scored very high on a voice self-assessment test. CONCLUSION Voice rehabilitation after LT is a complex and long-term process that requires the involvement of a team of specialists. The optimal anatomical conditions restored during surgery, the patient's motivation and the support of professionals make it possible to return to normal verbal communication.
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Affiliation(s)
- Hanna Mackiewicz-Nartowicz
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Lidia Nawrocka
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Anna Sinkiewicz
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Girard AO, Lake IV, Lopez CD, Kalsi R, Brandacher G, Cooney DS, Redett RJ. Vascularized composite allotransplantation of the penis: current status and future perspectives. Int J Impot Res 2021; 34:383-391. [PMID: 34711953 DOI: 10.1038/s41443-021-00481-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 12/13/2022]
Abstract
Given the multifunctional role of the penis in daily life, penile loss can be a physically and emotionally devastating injury. Options to restore penile loss have traditionally relied on autogenous free flap, local flaps, and skin grafts. These techniques provide satisfactory outcomes but carry high rates of urologic and prosthesis-related complications. Vascularized composite allotransplantation may offer a novel solution for these patients through reconstruction with true penile tissue. Still, penile transplants pose ethical, logistical, and psychosocial challenges. These obstacles are made more complex by the limited cases detailed in published literature. A review of the literature was conducted to assay current practices for penile reconstruction. Most modern complex penile reconstructions utilize autogenous pedicled or free tissue flaps, which may be harvested from a variety of donor sites. A total of five penile transplants have been described in the literature. Of these, four report satisfactory outcomes. The advent of genital allotransplantation has recently broadened the landscape of treatment for penile loss. Reconstruction using true penile tissue through vascularized penile allotransplantation has the possibility to engender increased penile function, sensation, and overall quality of life.
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Affiliation(s)
- Alisa O Girard
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Plastic Surgery, Rutgers - Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Isabel V Lake
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher D Lopez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richa Kalsi
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Damon S Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Al-Qurayshi Z, Wafa EI, Hoffman H, Chang K, Salem AK. Tissue-engineering the larynx: Effect of decellularization on human laryngeal framework and the cricoarytenoid joint. J Biomed Mater Res B Appl Biomater 2021; 109:2030-2040. [PMID: 33872461 DOI: 10.1002/jbm.b.34851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/06/2021] [Accepted: 04/08/2021] [Indexed: 11/12/2022]
Abstract
Decellularization approaches have been commonly used as alternative techniques to reconstruct tissues. However, due to the complex tissue compartmentation of the larynx, the decellularization process may not retain the characteristics necessary for the successful recreation of the larynx. The aim of this study was to assess the effect of the decellularization process on the framework of the human cadaveric larynx generally and the cricoarytenoid joint specifically. In this work, five freshly frozen human cadaveric larynges were decellularized utilizing a protocol that was previously demonstrated to be effective in decellularizing a porcine larynx. The decellularization protocol included: biological, chemical, and physical decellularization methods. Each specimen served as its own control to assess changes after decellularization. Studies and measurements included: histological, using Hematoxylin and Eosin (H&E) and Live/Dead™ stains; DNA quantification; micro-computed tomography (μ-CT) imaging; and biomechanical testing of the cricoarytenoid joints. The decellularization protocol took 12 days for each specimen. Microscopy of H&E stained samples demonstrated substantial removal of cells with preservation of the extracellular matrix that was more evident in cartilage than muscle specimens. Confocal microscope images of Live/Dead™ stained specimens also demonstrated almost complete removal of cells. Pre-decellularization cartilage-DNA quantity range was 27.0 to 336.8 ng/mg while post-decellularization DNA quantity range was 0 to 30.4 ng/mg (p = 0.031). For muscles, pre-decellularization DNA quantity range was 150.0 to 3,384.6 ng/mg, while post-decellularization DNA quantity range was 0 to 45.5 ng/mg (p = 0.031). μ-CT demonstrated preservation of the cartilaginous framework with a slight reduction of cricoarytenoid joint space. Furthermore, μ-CT demonstrated no significant reduction in the Housefield unit (p = 0.25) and mineral density (p = 0.25) after decellularization. Biomechanical testing demonstrated a non-significant reduction of forces required for anterior displacement of the arytenoid (mean reduction of forces, 0.1 ± 0.2 N, p = 0.16) and forces required for posterior displacement of the arytenoid (mean reduction of forces, 0.2 ± 0.3 N, p = 0.05). This study demonstrates effective decellularization of human larynges as evidenced by significant DNA depletion and preservation of extracellular matrix, which are outcomes that are required for a biological scaffold to regenerate a non-immunogenic larynx. The decellularization process caused minimal weakness in the cricoarytenoid joints due to treatment with multiple detergents and enzymes in the decellularization protocol.
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Affiliation(s)
- Zaid Al-Qurayshi
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Emad I Wafa
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | - Henry Hoffman
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kristi Chang
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Aliasger K Salem
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA
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Duisit J, Maistriaux L, Bertheuil N, Lellouch AG. Engineering Vascularized Composite Tissues by Perfusion Decellularization/Recellularization: Review. CURRENT TRANSPLANTATION REPORTS 2021. [DOI: 10.1007/s40472-021-00317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW Face transplantation represents vascularized composite allotransplantation (VCA) organ and became one of the most rewarding reconstructive options for severely disfigured patients. This review summarizes the past, current and future challenges of face transplantation, based on our experience and literature reports. RECENT FINDINGS In 2005, first partial face transplantation was reported by French team. In 2008, we have performed the US first near-total face transplantation. Currently, more than 40 face transplant cases were reported worldwide. Based on the outcomes of our three patients and the literature reports, face transplantation improved aesthetics, function and the quality of life of face transplant patients. However, there are still many challenges encountered including the side effects of immunosuppressive protocols, the psychological and social problems as well as the financial challenges which need to be address in the near future to maintain face transplantation in the armamentarium of reconstructive surgery. SUMMARY Currently, feasibility of face transplantation was confirmed; however, the life-long immunosuppressive protocols bearing serious side effects are still required to prevent face rejection. Thus, for the future of face and other VCA, novel approaches of cell-based therapies or engineered scaffolds should be developed to make face transplantation safer.
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Kaufman CL, Bhutiani N, Ramirez A, Tien HY, Palazzo MD, Galvis E, Farner S, Ozyurekoglu T, Jones CM. Current Status of Vascularized Composite Allotransplantation. Am Surg 2019. [DOI: 10.1177/000313481908500628] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The field of vascularized composite allotransplantation (VCA) has moved from a highly experimental procedure to, at least for some patients, one of the best treatment alternatives for catastrophic tissue loss or dysfunction. Although the worldwide experience is still limited, progress has been made in translation to the clinic, and hand transplantation was recently designated standard of care and is now covered in full by the British Health System. This progress is tempered by the long-term challenges of systemic immunosuppression, and the rapidly evolving indications for VCA such as urogenital transplantation. This update will cover the state of and recent changes in the field, and an update of the Louisville VCA program as our initial recipient, the first person to receive a hand transplant in the United States celebrates the 20th anniversary of his transplant. The achievements and complications encountered over the last two decades will be reviewed. In addition, potential directions for research and collaboration as well as practical issues of how third party payers and funding are affecting growth of the field are presented.
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Sánchez-Margallo FM, Moreno-Naranjo B, Pérez-López MDM, Abellán E, Domínguez-Arroyo JA, Mijares J, Santiago Álvarez I. Laparoscopic uterine graft procurement and surgical autotransplantation in ovine model. Sci Rep 2019; 9:8095. [PMID: 31147586 PMCID: PMC6543039 DOI: 10.1038/s41598-019-44528-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 05/16/2019] [Indexed: 11/23/2022] Open
Abstract
Currently, uterus transplantation (UTx) is a clinical option for infertile women. Over the past three decades, treating benign or malignant gynecological diseases with minimally invasive gynecological surgery has improved, providing significant advantages over conventional open surgery. This study addresses the method used for laparoscopic live-donor ovariohysterectomy and graft harvest from a sheep model. Using a microsurgical practice, ten grafts were autotransplanted after uterine perfusion. End-to-end anastomosis techniques were used to approximate veins and arteries. Follow-ups were carried out 2-months after surgery and postoperative studies included ultrasound scan, diagnostic hysteroscopy, vascular angiography, and exploratory laparoscopy. All transplants were completed without complications. After vascular anastomosis, total reperfusion of the tissue was accomplished in all animals without confirmation of arterial or venous thrombosis. Angiographic explorations did not show any statistically significant dissimilarity in the arterial diameters between the different examination times. 3-months after uterine transplantation all animals underwent assisted reproduction techniques. Patent uterine arteries were observed 4, 8 and 12 months after the transplant. 6-months after transplantation, six sheep (60%) became pregnant with assisted reproduction practices. We noticed an increase in the degree of fibrosis of the cervix samples in non-pregnant animals of the transplant group. Laparoscopic surgery can be an advantageous approach for the uterus retrieval procedure during uterine transplantation. However, larger sample sized reports are needed in order to accomplish validation, standardization and wider use of this route.
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Affiliation(s)
| | - Belén Moreno-Naranjo
- Laparoscopy Department, Jesús Usón Minimally Invasive Surgery Centre, 10071, Cáceres, Spain
| | | | - Elena Abellán
- Microsurgery Department, Jesús Usón Minimally Invasive Surgery Centre, 10071, Cáceres, Spain
| | | | - José Mijares
- Assisted Reproduction Unit, Jesús Usón Minimally Invasive Surgery Centre, 10071, Cáceres, Spain
| | - Ignacio Santiago Álvarez
- Instituto Extremeño de Reproducción Asistida (IERA), 06006 Badajoz, Spain
- Assisted Reproduction Unit, Jesús Usón Minimally Invasive Surgery Centre, 10071, Cáceres, Spain
- Anatomy and Cell Biology Department, School of Medicine, University of Extremadura, 06071, Badajoz, Spain
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Obongo R, Bon-Mardion N, Duclos C, Strunski V, Guerout N, Marie JP. Dual innervation may occur in a partially denervated muscle. Muscle Nerve 2018; 59:108-115. [PMID: 30121966 DOI: 10.1002/mus.26323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 11/07/2022]
Abstract
INTRODUCTION With a view to simplifying surgical techniques for selective laryngeal reinnervation, we addressed the question of whether it is feasible to receive additional innervation by a partially denervated muscle using an infrahyoid muscle model. METHODS In 90 rats (6 groups of 15), phrenic nerve transfer was used to reinnervate the sternothyroid muscle. In some cases, residual innervation by the original nerve was present. Three months later we performed electromyographic studies, contraction strength measurements, histologic assessment, and retrograde labeling. RESULTS Muscles reinnervated by the phrenic nerve had a greater "dual-response" rate (in terms of nerve latency, contraction strength, and retrograde labeling) than muscles in the control groups. DISCUSSION The phrenic nerve can impart its inspiratory properties to an initially denervated strap muscle-even when residual innervation is present. The preservation of contractile potential confirmed the feasibility of dual innervation in a previously injured muscle. Muscle Nerve 59:108-115, 2019.
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Affiliation(s)
- Rais Obongo
- Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), EA3830-GRHV, 76000 Rouen, France
| | - Nicolas Bon-Mardion
- Otorhinolaryngology, Head and Neck Surgery Department, Rouen University Hospital, Rouen, France
| | - Celia Duclos
- Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), EA3830-GRHV, 76000 Rouen, France
| | - Vladimir Strunski
- Otorhinolaryngology, Head and Neck Surgery Department, Amiens University Hospital, Amiens, France
| | - Nicolas Guerout
- Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), EA3830-GRHV, 76000 Rouen, France
| | - Jean-Paul Marie
- Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), EA3830-GRHV, 76000 Rouen, France
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Hung SH, Su CH, Lin SE, Tseng H. Preliminary experiences in trachea scaffold tissue engineering with segmental organ decellularization. Laryngoscope 2016; 126:2520-2527. [PMID: 26928374 DOI: 10.1002/lary.25932] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/22/2015] [Accepted: 01/27/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Ideal methods for reconstructing the tracheal structure and restoring tracheal function following damage to the trachea or removal of the trachea have not been developed. The purpose of this study is to evaluate the feasibility of using a whole segment decellularized tracheal scaffold to reconstruct the trachea. STUDY DESIGN Prospective experimental design. SETTING In vivo rabbit model. METHODS Trachea scaffolds were created using our previously developed freeze-dry-sonication-sodium dodecyl sulfate (SDS), [FDSS] decellularization process. After histological and mechanical testing, the scaffolds were transplanted orthotopically into segmental defects in New Zealand White Rabbits (n = 9). Another three rabbits receiving the sham operation with autologous trachea transplantations served as the control group. Two weeks after transplantation, the grafts were evaluated endoscopically and histologically. RESULTS The mechanical properties of the decellularized trachea segment did not differ significantly from the fresh native trachea. After transplantation, whereas the autograft in the control group showed full integration and functional recovery, all of the rabbits in the decellularized scaffold transplantation group died within 7∼24 days. Although significant collapse of the tracheal tubular structures was noted, full respiratory epithelium regeneration was observed in the rabbits that survived more than 2 weeks. CONCLUSION The FDSS decellularization process is effective in creating whole-segment, subtotally decellularized trachea scaffolds. However, although the respiratory epithelium regeneration on the inner surface appeared to be satisfactory, the tubular structures were not able to be maintained after transplantation, which ultimately led to the death of the animals. LEVEL OF EVIDENCE NA Laryngoscope, 126:2520-2527, 2016.
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Affiliation(s)
- Shih-Han Hung
- Department of Otolaryngology, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan.,Department of Otolaryngology, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chin-Hui Su
- Department of Otolaryngology, School of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Otorhinolaryngology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Sey-En Lin
- Department of Pathology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - How Tseng
- Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan. .,Department of Biochemistry and Molecular Cell Biology, School of Medicine , College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Siemionow M. Vascularized composite allotransplantation: a new concept in musculoskeletal regeneration. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:266. [PMID: 26507199 DOI: 10.1007/s10856-015-5601-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/05/2015] [Indexed: 06/05/2023]
Abstract
Over the past 20 years, the fields of biomaterial sciences and tissue engineering have evolved into new clinically relevant applications including regenerative medicine and cell based therapies. Tissue engineering therapies are based on different types of materials and scaffolds combined with cells and submitted to engineering processes in order to create bio-scaffolds which will improve or replace biological functions. Despite the effort, only a few therapies, such as bone, cartilage and nerve, succeeded in clinical applications. Furthermore, the major drawback in standard application of these therapies was the critical size defects which could be covered with engineered materials, as well as inability to provide sustainable vascular supply to the created bio-scaffolds. In 1998, the first successful hand transplantation was performed in France, and the field of vascularized composite allotransplantation (VCA) was introduced into the armamentarium of reconstructive surgery (Dubernard in Am J Transplant 5(6):1580-1, 2005; Petruzzo et al. in Am J Transplant 6(7):1718-24, 2006; Lanzetta et al. in Transplantation 79(9):1210-4, 2005). As a result, a new generation of transplants including hand, face, larynx abdominal wall, lower extremities and penile transplantation became available to patients who had lost these unique organs and were previously unable to achieve restored function using standard reconstructive procedures. Ethical debate on the need for life-long immunosuppressive therapy to prevent rejection of the VCA overshadowed the success of face and hand transplants. Thus, a new, challenging opportunity developed to combine approaches of tissue engineering and regenerative medicine and ultimately restore the framework, function, aesthetics and survival of the VSA transplants. This overview presents the unique opportunities of merging established and new technologies into the burgeoning field of reconstructive transplantation.
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Affiliation(s)
- Maria Siemionow
- University of Illinois at Chicago, 900 South Ashland, MC 944, Chicago, IL, 60640, USA.
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Transplantation of the Mystacial Pad. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jo HK, Park JW, Hwang JH, Kim KS, Lee SY, Shin JH. Risk acceptance and expectations of laryngeal allotransplantation. Arch Plast Surg 2014; 41:505-12. [PMID: 25276642 PMCID: PMC4179354 DOI: 10.5999/aps.2014.41.5.505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/09/2014] [Accepted: 06/14/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Laryngeal allotransplantation (LA) is a technique involving transplantation of a deceased donor's larynx into a recipient, and it may be substituted for conventional laryngeal reconstruction. There are widely different views on LA, as the recipient is administered continuous, potentially life-threatening, immunosuppressive therapy for a functional or aesthetic result, which is not directly related to life extension. The purpose of this study was to analyze the difference in risk acceptance and expectations of LA between four population groups. METHODS A survey was performed to examine patients' risk acceptance and expectations of LA. The survey included 287 subjects in total (general public, n=100; kidney transplant recipients, n=53; post-laryngectomy patients, n=34; doctors, n=100), using a Korean translated version of the louisville instrument for transplantation (LIFT) questionnaire. RESULTS All four groups responded differently at various levels of their perception in risk acceptance and expectations. The kidney transplant recipients reported the highest risk acceptance and expectations, and the doctor group the lowest. CONCLUSIONS This study examined the disparate perception between specific population groups of the risks and benefits of using LA for the promotion of the quality of life. By addressing the information gaps about LA in the different populations that have been highlighted from this survey, we suggest that LA can become a more viable alternative to classical surgery with resultant improved quality of life for patients.
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Affiliation(s)
- Hyun Kyo Jo
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jang Wan Park
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Ha Hwang
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang Seog Kim
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sam Yong Lee
- Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
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Debry C, Dupret-Bories A, Vrana NE, Hemar P, Lavalle P, Schultz P. Laryngeal replacement with an artificial larynx after total laryngectomy: The possibility of restoring larynx functionality in the future. Head Neck 2014; 36:1669-73. [DOI: 10.1002/hed.23621] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/22/2013] [Accepted: 02/06/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Christian Debry
- Institut National de la Santé et de la Recherche Médicale; INSERM, UMR-S 1121, “Biomatériaux et Bioingénierie,” 11 rue Humann F-67085 Strasbourg Cedex France
- Faculté de Chirurgie Dentaire; Université de Strasbourg, 1 Place de l'Hôpital; 67000 Strasbourg France
- Hôpitaux Universitaires de Strasbourg, Service Oto-Rhino-Laryngologie; 67098 Strasbourg France
| | - Agnes Dupret-Bories
- Institut National de la Santé et de la Recherche Médicale; INSERM, UMR-S 1121, “Biomatériaux et Bioingénierie,” 11 rue Humann F-67085 Strasbourg Cedex France
- Hôpitaux Universitaires de Strasbourg, Service Oto-Rhino-Laryngologie; 67098 Strasbourg France
| | - Nihal E. Vrana
- Protip SAS, 8 Place de l'Hôpital; 67000 Strasbourg France
| | - Patrick Hemar
- Hôpitaux Universitaires de Strasbourg, Service Oto-Rhino-Laryngologie; 67098 Strasbourg France
| | - Philippe Lavalle
- Institut National de la Santé et de la Recherche Médicale; INSERM, UMR-S 1121, “Biomatériaux et Bioingénierie,” 11 rue Humann F-67085 Strasbourg Cedex France
- Faculté de Chirurgie Dentaire; Université de Strasbourg, 1 Place de l'Hôpital; 67000 Strasbourg France
| | - Philippe Schultz
- Institut National de la Santé et de la Recherche Médicale; INSERM, UMR-S 1121, “Biomatériaux et Bioingénierie,” 11 rue Humann F-67085 Strasbourg Cedex France
- Hôpitaux Universitaires de Strasbourg, Service Oto-Rhino-Laryngologie; 67098 Strasbourg France
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Urinary excretion of oxidative damage markers in a rat model of vascularized composite allotransplantation. Plast Reconstr Surg 2013; 132:530e-541e. [PMID: 24076700 DOI: 10.1097/prs.0b013e3182a0141f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vascularized composite allotransplantation is an emerging field of transplantation that provides a potential treatment for complex tissue defects after traumatic loss or tumor resection and for the repair of congenital abnormalities. However, vascularized composite allotransplantation recipients have suffered from acute and chronic graft rejection that is associated with oxidative stress. This study investigated the oxidative damage in a rat vascularized composite allotransplantation model by measuring three urinary biomarkers, 8-oxo-7,8-dihydroguanine (8-oxoGua), 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), and malondialdehyde. METHODS Rats received two different immunosuppressants, including cyclosporine A and mycophenolate mofetil after transplantation, with one group also receiving mesenchymal stem cells before transplantation. Urine was collected and analyzed for 8-oxo-7,8-dihydroguanine, 8-oxo-7,8-dihydro-2'-deoxyguanosine, and malondialdehyde by liquid chromatography coupled to tandem mass spectometry methods. RESULTS Rats undergoing vascularized composite allotransplantation had higher urinary levels of 8-oxo-7,8-dihydroguanine, 8-oxo-7,8-dihydro-2'-deoxyguanosine, and malondialdehyde compared with rats undergoing syngeneic transplantation. Cyclosporine A/mycophenolate mofetil following treatment prolonged the allograft survival in a dose-dependent manner. Compared with rats undergoing vascularized composite allotransplantation with cyclosporine A/mycophenolate mofetil treatment alone, rats undergoing mesenchymal stem cell combined treatment showed the longest allograft survival, and had approximately 50 percent lower urinary levels of malondialdehyde together with approximately 2.7-times higher levels of 8-oxo-7,8-dihydroguanine. CONCLUSIONS Mesenchymal stem cell combined treatment efficiently managed oxidative stress in rats undergoing vascularized composite allotransplantation, and urinary 8-oxo-7,8-dihydroguanine and malondialdehyde could be regarded as good responders to the mesenchymal stem cell therapy.
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Tacrolimus enhances the recovery of normal laryngeal muscle fibre distribution after reinnervation. The Journal of Laryngology & Otology 2012; 126:1155-8. [PMID: 22947322 DOI: 10.1017/s0022215112001788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the recovery of various muscle fibre types in the posterior cricoarytenoid muscle after laryngeal reinnervation in the rat, and to determine the influence of tacrolimus on this process. METHODS Four groups of rats underwent resection and anastomosis of the left vagus nerve, and were administered either tacrolimus at a low dose or an immunosuppressive dose, or cyclosporin A at a low dose or an immunosuppressive dose. A fifth group received surgery alone, and a sixth group received neither surgery nor drug treatment (healthy group). Muscles were removed for immunohistochemical analysis 45 days after surgery. RESULTS There was no difference in the proportion of types 1, 2a and 2b muscle fibres, comparing the immunosuppressive tacrolimus group and the healthy group, whereas there were fewer type 1 fibres in the group receiving surgery alone, compared with the healthy group (7 vs 12.1 per cent, respectively; p = 0.0303). CONCLUSION Tacrolimus enhanced the recovery of normal laryngeal muscle fibres after reinnervation in the rat, indicating a possible role in laryngeal transplantation.
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Mitchell O, Durrani A, Price R. Rehabilitation of patients following major head and neck cancer surgery. ACTA ACUST UNITED AC 2012; 21:S31-7. [DOI: 10.12968/bjon.2012.21.sup10.s31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Amer Durrani
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge
| | - Richard Price
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge
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Fishman JM, Ansari T, Sibbons P, De Coppi P, Birchall MA. Decellularized rabbit cricoarytenoid dorsalis muscle for laryngeal regeneration. Ann Otol Rhinol Laryngol 2012; 121:129-38. [PMID: 22397223 DOI: 10.1177/000348941212100210] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Although considerable progress has been made in regenerative medicine, a quantum step would be the replacement and/or regeneration of functional muscle tissue. For example, although patients' airways can now be successfully replaced with stem cell-based techniques, a much greater patient need would be addressed by regeneration of the muscles required for engineering a functional larynx, in which active movement is critical. The rabbit cricoarytenoid dorsalis muscle was chosen for the present study because it is equivalent to the posterior cricoarytenoid muscle, the only significant abductor muscle in human larynges. METHODS Rabbit cricoarytenoid dorsalis muscles were harvested, and different decellularization methods were compared by use of a combination of histologic, immunohistochemical, and molecular techniques. Decellularized scaffolds were implanted into Sprague-Dawley rats as part of a 2-week biocompatibility study to assess immunogenicity. RESULTS Decellularization with a combination of latrunculin B, potassium iodide, potassium chloride, and deoxyribonuclease resulted in total DNA clearance and reduced levels of major histocompatibility complex class II expression, with relative preservation of the scaffold's structural integrity (collagen, elastin, and glycosaminoglycan content). The scaffolds showed minimal signs of rejection at 2 weeks in a cross-species (xenotransplantation) study. CONCLUSIONS Decellularized laryngeal muscles, which are nonimmunogenic, may provide the optimal scaffold source for the generation of a fully functional tissue-engineered larynx.
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Affiliation(s)
- Jonathan M Fishman
- University College London Institute of Child Health, 30 Guilford St, London WC1N 1EH, United Kingdom
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Saso S, Logan K, Abdallah Y, Louis LS, Ghaem-Maghami S, Smith JR, Del Priore G. Use of cyclosporine in uterine transplantation. J Transplant 2011; 2012:134936. [PMID: 22132302 PMCID: PMC3216255 DOI: 10.1155/2012/134936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/07/2011] [Accepted: 09/21/2011] [Indexed: 11/18/2022] Open
Abstract
Uterine transplantation has been proposed as a possible solution to absolute uterine factor infertility untreatable by any other option. Since the first human attempt in 2000, various teams have tried to clarify which immunosuppressant would be most suitable for protecting the allogeneic uterine graft while posing a minimal risk to the fetus. Cyclosporine A (CsA) is an immunosuppressant widely used by transplant recipients. It is currently being tested as a potential immunosuppressant to be used during UTn. Its effect on the mother and fetus and its influence upon the graft during pregnancy have been of major concern. We review the role of CsA in UTn and its effect on pregnant transplant recipients and their offspring.
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Affiliation(s)
- Srdjan Saso
- Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Karl Logan
- Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Yazan Abdallah
- Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Louay S. Louis
- Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Sadaf Ghaem-Maghami
- Gynaecological Oncology, West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - J. Richard Smith
- Gynaecological Oncology, West London Gynaecological Cancer Centre, Queen Charlotte's Hospital, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Giuseppe Del Priore
- Melvin and Bren Simon Cancer Center, Indianapolis, Indiana University School of Medicine, Simon Cancer Center, Indianapolis, IN 46202, USA
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Iseh K. Total laryngectomy for laryngeal cancer in a nigerian tertiary health center: prognosis and outcome. J Surg Tech Case Rep 2011; 3:23-30. [PMID: 22022650 PMCID: PMC3192514 DOI: 10.4103/2006-8808.78467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Advanced laryngeal cancers presenting with upper airway obstruction are a common scenario in Sub-Saharan Africa, requiring operative intervention as a priority. Objective: To assess outcome of total laryngectomy as a treatment option in the surgical management of advanced laryngeal cancers in a tertiary health institution in northwestern Nigeria. Materials and Methods: A retrospective analysis of total laryngectomies for laryngeal cancers carried out by one surgeon from December 2000 to August 2009. Results: Out of 30 patients with histologically diagnosed laryngeal cancer, 18 were treated with total laryngectomy Fourteen (77.8%) were males, while 4 (22.2%) were females, with a male-to-female ratio of 3.5:1. The age range was 20-70 years with a mean age of 47years for males and 33.8 years for females. Total laryngectomy was carried out on T4 lesions (100%), with preoperative tracheostomy (100%) carried out as an emergency measure to relieve upper airway obstruction. Two female patients had safe vaginal deliveries after their surgeries. Although all patients were referred for radiotherapy, only 6 (33.3%) patients could afford postoperative radiotherapy, with a 5-year survival rate of 33.3%; while all others could not afford the cost of radiotherapy treatment, which was to be carried out at a center about 5 hours drive away from our center. Seven (38.9%) patients presented with recurrent neck nodal disease, while 3 (16.7%) had carotid blow-out hemorrhage that was fatal. Conclusion: Total laryngectomy remains an important surgical modality of treatment for advanced laryngeal cancers, as it affords the patient an opportunity of longer survival when combined with postoperative radiotherapy. It is superior to ‘radiotherapy only’ or ‘surgery only’ or nothing.
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Affiliation(s)
- Kufre Iseh
- Department of Otorhinolaryngology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Current status of surrogacy in Japan and uterine transplantation research. Eur J Obstet Gynecol Reprod Biol 2011; 158:135-40. [DOI: 10.1016/j.ejogrb.2011.04.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/26/2011] [Accepted: 04/29/2011] [Indexed: 11/21/2022]
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Birchall MA, Kingham PJ, Murison PJ, Ayling SM, Burt R, Mitchard L, Jones A, Lear P, Stokes CR, Terenghi G, Bailey M, Macchiarini P. Laryngeal transplantation in minipigs: vascular, myologic and functional outcomes. Eur Arch Otorhinolaryngol 2011; 268:405-14. [PMID: 20842506 PMCID: PMC3192951 DOI: 10.1007/s00405-010-1355-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 07/25/2010] [Indexed: 12/01/2022]
Abstract
There is no effective way of replacing all the functions of the larynx in those requiring laryngectomy. Regenerative medicine offers promise, but cannot presently deliver implants with functioning neuromuscular units. A single well-documented laryngeal transplant in man was a qualified success, but more information is required before clinical trials may be proposed. We studied the early response of the larynx to laryngeal transplantation between 17 pairs of NIH minipigs full matched at the MHC2 locus. Following iterative technical improvements, pigs had good swallowing and a patent airway at 1 week. No significant changes in mucosal blood flux were observed compared with pre-operative measurements. Changes in muscle morphology and fibre phenotype were observed in transplant muscles retrieved after 7 days: the levels of fast and slow myosin heavy chain (MyHC) protein were reduced and embryonic MyHC was up regulated consistent with denervation induced atrophy. At 1 week laryngeal transplantation can result in good swallowing, and is not associated with clinical evidence of ischemia-reperfusion injury in MHC-matched pigs.
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Affiliation(s)
- M A Birchall
- Department of Clinical Sciences at South Bristol, Bristol, UK.
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Lott DG, Russell JO, Khariwala SS, Dan O, Strome M. Ten-Month Laryngeal Allograft Survival with Use of Pulsed Everolimus and Anti—αβ T-Cell Receptor Antibody Immunosuppression. Ann Otol Rhinol Laryngol 2011; 120:131-6. [DOI: 10.1177/000348941112000210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: The risks of daily immunosuppression limit the use of laryngeal transplantation as a reconstructive option. Pulsed immunosuppressive dosing can lessen these risks. The study objective was to develop a long-term pulsing regimen that minimizes exposure to immunosuppressive agents. Methods: Rat laryngeal transplantation was performed. Everolimus (1 mg/kg per day) and anti–αβ T-cell receptor (TCR) antibodies (250 μg) were given for 7 days beginning 1 day before transplantation and for 5 days beginning on day 90 after transplantation. On day 180, group 1 (n = 5) received the initial regimen for 3 days, and group 2 (n = 5) received everolimus (1 mg/kg per day) until euthanization, which occurred when parathyroid hormone (PTH) levels dropped to less than 11 pg/mL or at 300 days. Results: Four of the 5 rats in group 1 had normal PTH levels at 300 days. The PTH level for 1 rat was less than 11 pg/mL at 270 days. In group 2, none of the 5 rats had normal PTH levels at 300 days. Two had PTH levels below 11 pg/mL at 270 days, and 3 had PTH levels below 11 pg/mL at 300 days. The allografts that survived beyond 300 days had an essentially normal histologic appearance. Conclusions: Pulsed immunosuppression prevented allograft rejection for 10 months and was more effective than daily everolimus. Short-term perioperative therapy followed by pulsed, tapered dosing is a viable alternative to traditional regimens and may decrease associated risks.
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Abstract
BACKGROUND Esophageal defects are reconstructed using a variety of methods and tissue types. The choice depends on the location of the defect, the condition of the patient, and the flaps that are available for reconstruction. Often, patients with esophageal defects also lack a mechanism for voice production following a total laryngectomy procedure. METHODS A review of the literature was performed for esophagus reconstruction and voice rehabilitation following laryngectomy. Methods of voice restoration using intestinal transfers are presented based on the authors' experience. RESULTS Several methods of esophagus and voice restoration can achieve excellent functional outcomes. CONCLUSION Esophagus reconstruction and voice rehabilitation following esophageal resection and total laryngectomy are possible using a variety of flaps with good functional outcomes.
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Brännström M, Wranning CA, Altchek A. Experimental uterus transplantation. Hum Reprod Update 2009; 16:329-45. [PMID: 19897849 DOI: 10.1093/humupd/dmp049] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Uterus transplantation (UTx) is developed in animal models as a future method to treat uterine factor infertility. METHODS All published studies in the area of UTx research were identified. Aspects relating to surgery, cold-ischemia/reperfusion, rejection, immunosuppression, pregnancy, ethics and institutional requirements were examined. RESULTS Uterus retrieval surgery has been solved in animals, including primates. Studies on cold-ischemia/reperfusion indicate an ischemic tolerance of >24 h. The transplantation procedure, with vascular anastomosis, has not been fully developed in animal models, indicated by frequent thrombosis formation. Pregnancies have only been reported in syngenic/auto-UTx animal models. Several ethical issues in relation to UTx, and requirements for a team that would be suitable to undertake human UTx, exist. CONCLUSION Much research on UTx has been performed in appropriate animal models. Several aspects of the procedure have been optimized but some remain to be solved. It is predicted that the research will soon reach a stage that could merit introduction of human UTx as an experimental procedure.
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Affiliation(s)
- Mats Brännström
- Department of Obstetrics & Gynecology, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Rahhal DN, Xu H, Huang WC, Wu S, Wen Y, Huang Y, Ildstad ST. Dissociation between peripheral blood chimerism and tolerance to hindlimb composite tissue transplants: preferential localization of chimerism in donor bone. Transplantation 2009; 88:773-81. [PMID: 19920776 PMCID: PMC2780434 DOI: 10.1097/tp.0b013e3181b47cfa] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mixed chimerism induces donor-specific tolerance to composite tissue allotransplants (CTAs). In the present studies, we used a nonmyeloablative conditioning approach to establish chimerism and promote CTA acceptance. METHODS Wistar Furth (RT1A(u)) rats were conditioned with 600 to 300 cGy total body irradiation (TBI, day-1), and 100 x 10(6) T-cell-depleted ACI (RT1A(abl)) bone marrow cells were transplanted on day 0, followed by a 11-day course of tacrolimus and one dose of antilymphocyte serum (day 10). Heterotopic osteomyocutaneous flap transplantation was performed 4 to 6 weeks after bone marrow transplantation. RESULTS Mixed chimerism was initially achieved in almost all recipients, but long-term acceptance of CTA was only achieved in rats treated with 600 cGy TBI. When anti-alphabeta-T-cell receptor (TCR) monoclonal antibody (mAb) (day-3) was added into the regimens, donor chimerism was similar to recipients preconditioned without anti-alphabeta-TCR mAb. However, the long-term CTA survival was significantly improved in chimeras receiving more than or equal to 300 cGy TBI plus anti-alphabeta-TCR mAb. Higher levels of donor chimerism were associated with CTA acceptance. The majority of flap acceptors lost peripheral blood chimerism within 6 months. However, donor chimerism persisted in the transplanted bone at significantly higher levels compared with other hematopoietic compartments. The compartment donor chimerism may be responsible for the maintenance of tolerance to CTA. Long-term acceptors were tolerant to a donor skin graft challenge even in the absence of peripheral blood chimerism. CONCLUSIONS Mixed chimerism established by nonmyeloablative conditioning induces long-term acceptance of CTA, which is associated with persistent chimerism preferentially in the transplanted donor bone.
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Affiliation(s)
- Dina N Rahhal
- Institute for Cellular Therapeutics, University of Louisville, Louisville, KY 40202-1760, USA.
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Abstract
Restoration of amputations and disfigurement are represented in ancient mythology, but the modern history of composite tissue allotransplantation begins with World War II injuries that generated seminal immunologic experiments by Medawar and co-workers. These studies led to the first successful human allografts in the 1950s by Peacock with composite tissue and Murray and co-workers with solid organs. Pharmacologic immunosuppression brought rapid growth of solid organ transplantation over the next 50 years, but composite tissue transplantation virtually disappeared. This evolution was judged to be a consequence of the greater antigenicity of skin, which that was insurmountable by the available immunosuppression. In the mid-1990s, progress in immunosupression allowed skin-bearing grafts, led by successful hand transplants, which produced a renaissance in composite tissue allotransplantation. Since then, graft types have expanded to over 10, and graft numbers to over 150, with success rates that equal or exceed solid organs. The field has emerged as one of the most exciting in contemporary medicine, although accompanied by substantial challenges and controversy. This paper reviews the origins and progress of this field, assessing its potential for future evolution.
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Hom DB, Sun GH, Elluru RG. A contemporary review of wound healing in otolaryngology: Current state and future promise. Laryngoscope 2009; 119:2099-110. [DOI: 10.1002/lary.20561] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Mathes DW, Schlenker R, Ploplys E, Vedder N. A survey of north american hand surgeons on their current attitudes toward hand transplantation. J Hand Surg Am 2009; 34:808-14. [PMID: 19410983 DOI: 10.1016/j.jhsa.2009.01.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2008] [Revised: 01/16/2009] [Accepted: 01/20/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Although composite tissue allotransplantation (CTA) is unparalleled in its potential to reconstruct "like with like," the risk-benefit ratio and clinical indications are difficult to determine. We examined current attitudes regarding the emerging field of CTA from those who treat complex hand injuries. METHODS A web-based survey regarding CTA was sent to members of the American Society for Surgery of the Hand, which identified their demographic data and practice profiles. Respondents' support for CTA and their assessment of the level of risk associated with these procedures were addressed. Additional questions focused on the clinical application of CTA with current immunosuppression, ethical issues surrounding CTA, and the indications for hand transplantation. Finally, 2 clinical situations that closely mirrored past hand transplantations were presented, and members evaluated their suitability for allotransplantation. RESULTS A total of 474 surgeons responded to the survey (22% response rate), who were divided in their opinion of hand transplantation with 24% in favor, 45% against, and 31% undecided. The majority (69%) consider this surgery to be a high-risk endeavor; however, a large percentage (71%) still believe it to be an ethical procedure when performed on properly selected patients. The most accepted indications for hand transplantation were loss of bilateral hands (78%) and amputation of a dominant hand (32%). Only 16% were in favor of performing transplants with the immunosuppression available today. In response to the clinical situation, 66% would offer transplantation to a bilateral hand amputee, whereas only 9% would offer transplantation to a patient with diabetes who had lost his or her dominant hand. CONCLUSIONS This survey demonstrates support for hand allotransplantation as a solution for dominant-hand and bilateral hand amputees. However, surgeons continue to be concerned about the adverse effects of immunosuppression and the risks of acute and chronic rejection, and many want to wait for the development of better immunologic treatment options.
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Affiliation(s)
- David W Mathes
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA 98195, USA.
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Gordon C, Siemionow M, Zins J. Composite Tissue Allotransplantation: A Proposed Classification System Based on Relative Complexity. Transplant Proc 2009; 41:481-4. [DOI: 10.1016/j.transproceed.2009.01.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Composite Tissue Transplantation: A Stage Between Surgical Reconstruction and Cloning. Artif Organs 2009. [DOI: 10.1007/978-1-84882-283-2_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Swearingen B, Ravindra K, Xu H, Wu S, Breidenbach WC, Ildstad ST. Science of composite tissue allotransplantation. Transplantation 2008; 86:627-35. [PMID: 18791440 PMCID: PMC2629383 DOI: 10.1097/tp.0b013e318184ca6a] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The science of composite tissue allotransplantation (CTA) is rooted in progressive thinking by surgeons, fueled by innovative solutions, and aided by understanding the immunology of tolerance and rejection. These three factors have allowed CTA to progress from science fiction to science fact. Research using preclinical animal models has allowed an understanding of the antigenicity of complex tissue transplants and mechanisms to promote graft acceptance. As a result, translation to the clinic has shown that CTA is a viable treatment option well on the way of becoming a standard of care for those who have lost extremities and suffered large tissue defects. The field of CTA has been progressing exponentially over the past decade. Transplantation of hands, larynx, vascularized knee, trachea, face, and abdominal wall has been performed. Several important observations have emerged from translation to the clinic. Although it was predicted that rejection would pose a major limitation, this has not proven true. In fact, steroid-sparing protocols for immunosuppression that have been successfully used in renal transplantation are sufficient to prevent rejection of limbs. Although skin is highly antigenic when transplanted alone in animal models, when part of a CTA, it has not proven to be. Chronic rejection has not been conclusively demonstrated in hand transplant recipients and is difficult to induce in rodent models of CTA. This review focuses on the science of CTA, provides a snapshot of where we are in the clinic, and discusses prospects for the future to make the procedures even more widely available.
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Affiliation(s)
| | | | - Hong Xu
- Institute for Cellular Therapeutics, Louisville, KY
| | - Shengli Wu
- Institute for Cellular Therapeutics, Louisville, KY
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Ravindra KV, Wu S, Bozulic L, Xu H, Breidenbach WC, Ildstad ST. Composite tissue transplantation: a rapidly advancing field. Transplant Proc 2008; 40:1237-48. [PMID: 18589081 PMCID: PMC2692668 DOI: 10.1016/j.transproceed.2008.04.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Composite tissue allotransplantation (CTA) is emerging as a potential treatment for complex tissue defects. It is currently being performed with increasing frequency in the clinic. The feasibility of the procedure has been confirmed through 30 hand transplantation, 3 facial reconstructions, and vascularized knee, esophageal, and tracheal allografts. A major drawback for CTA is the requirement for lifelong immunosuppression. The toxicity of these agents has limited the widespread application of CTA. Methods to reduce or eliminate the requirement for immunosuppression and promote CTA acceptance would represent a significant step forward in the field. Multiple studies suggest that mixed chimerism established by bone marrow transplantation promotes tolerance resulting in allograft acceptance. This overview focuses on the history and the exponentially expanding applications of the new frontier in CTA transplantation: immunology associated with CTA; preclinical animal models of CTA; clinical experience with CTA; and advances in mixed chimerism-induced tolerance in CTA. Additionally, some important hurdles that must be overcome in using bone marrow chimerism to induce tolerance to CTA are also discussed.
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Affiliation(s)
- K V Ravindra
- Department of Surgery, University of Louisville, Louisville, Kentucky, USA
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Kochilas X, Bibas A, Xenellis J, Anagnostopoulou S. Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery. Clin Anat 2008; 21:99-105. [PMID: 18288760 DOI: 10.1002/ca.20604] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Injury of the external branch of the superior laryngeal nerve (EBSLN) increases the morbidity following a variety of neck procedures and can have catastrophic consequences in people who use their voice professionally. Identification and preservation of the EBSLN are thus important in thyroidectomy, parathyroidectomy, carotid endarterectomy, and anterior cervical spine procedures, where the nerve is at risk. There are large variations in the anatomical course of the EBSLN, which makes the intraoperative identification of the nerve challenging. The topographic relationship of the EBSLN to the superior thyroid artery and the upper pole of the thyroid gland are considered by many authors to be the key point for identifying the nerve during surgery of the neck. The classifications by Cernea et al. ([1992a] Head Neck 14:380-383; [1992b] Am. J. Surg. 164:634-639) and by Kierner et al. ([1998] Arch. Otolaryngol. Head Neck Surg. 124:301-303), as well as clinically important connections are discussed in detail. Along with sound anatomical knowledge, neuromonitoring is helpful in identifying the EBSLN during neck procedures. The clinical signs of EBSLN injury include hoarseness, decreased voice projection, decreased pitch range, and fatigue after extensive voice use. Videostroboscopy, electromyography, voice analysis, and electroglottography can provide crucial information on the function of the EBSLN following neck surgery.
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Affiliation(s)
- Xenophon Kochilas
- Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Greece
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Trasplante de la laringe: ¿una opción terapéutica para el siglo XXI? Revisión de la literatura. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rinker B, Cui XD, Cibull ML, Fink BF, Gao DY, Vasconez HC. Cryopreservation of composite tissue transplants. Hand (N Y) 2008; 3:17-23. [PMID: 18780115 PMCID: PMC2528968 DOI: 10.1007/s11552-007-9062-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 06/20/2007] [Indexed: 10/23/2022]
Abstract
Composite tissue allotransplantation holds great promise for upper extremity reconstruction but is limited by donor part availability. Cryopreservation may increase the availability of donor parts and even reduce antigenicity. The purpose of the study was to evaluate the viability of cryopreserved composite tissues and to demonstrate the feasibility of microvascular isotransplantation of cryopreserved composite flaps. Twenty epigastric flaps were harvested from Lewis rats. Ten flaps were analyzed fresh. Ten flaps were perfused with dimethyl sulfoxide (DMSO)/trehelose cryoprotectant agent (CPA), frozen by controlled cooling to -140 degrees C, and stored for 2 weeks. Flaps were evaluated by factor VIII endothelial staining and MTT tetrazolium salt assay. For the in vivo phase, 30 flaps were harvested. Ten were transplanted fresh to isogenetic recipient animals, ten were perfused with CPA and transplanted, and ten were cryopreserved for 2 weeks, thawed, and transplanted. All cryopreserved samples displayed intact vascular endothelia on factor VIII staining. On MTT analysis, the epithelial viability index for the cryopreserved samples was not significantly different from fresh controls (p = 0.12). All freshly transplanted flaps (10/10) were viable at 60 days. Nine of ten flaps in the perfused/transplanted group were viable at 60 days. Survival of cryopreserved/transplanted flaps ranged from 5 to 60 days. The skin and vascular endothelial components of composite tissue flaps appear to retain their viability after cryopreservation. The in vivo studies demonstrate that the long-term survival of cryopreserved composite tissue transplants is feasible and support an indirect injury, rather than direct injury from freezing or cryoprotectant agents, as the mechanism of flap loss.
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Affiliation(s)
- Brian Rinker
- Division of Plastic Surgery, University of Kentucky, Lexington, KY, USA.
| | - Xiangdong D. Cui
- Division of Plastic Surgery, University of Kentucky, Lexington, KY USA ,Department of Mechanical Engineering and Center for Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Michael L. Cibull
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY USA
| | - Betsy F. Fink
- Division of Plastic Surgery, University of Kentucky, Lexington, KY USA
| | - Dayong Y. Gao
- Division of Plastic Surgery, University of Kentucky, Lexington, KY USA ,Department of Mechanical Engineering and Center for Biomedical Engineering, University of Kentucky, Lexington, KY USA
| | - Henry C. Vasconez
- Division of Plastic Surgery, University of Kentucky, Lexington, KY USA
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Larynx Transplant: A Therapeutic Option for the 21st Century? Literature Review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70208-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
INTRODUCTION Laryngeal transplantation is a possibility for patients with irreversible laryngeal disease, such as complex trauma and larynx cancer. The objective of performing this procedure was to solve problems that these patients face with a laryngectomy. The medical literature has reviews about larynx transplantations, but almost nothing about the larynx donor. The following is our experience on management of these donors. MATERIALS AND METHODS Selection criteria was as follows: (1) 18-50 years old; (2) gender and ABO blood type matched between donor and recipient; (3) No abuse of tobacco, cocaine, and marijuana, (4) tracheal intubation time <3 days; and (5) time in the intensive care unit <7 days. The preservation was simple hypothermia with larynx infusion via the carotid artery with University of Wisconsin solution. RESULTS Between 2001 and 2006, we managed 25 donors, among whom 12 grafts were discarded. The 13 larynx donors were of average age 27.2 +- 7.9 years and their cause of death was head trauma. Each was of male and 12 were multiorgan donors. Three donors had previous consumption of tobacco and 2 donors of marijuana. There were 2 cases of acute rejection episodes. Graft survival rate at 2 years was 90%. DISCUSSION These donors may have differences from other multiorgan donors: (1) they do not require strict fluid management; (2) vasoactive agents may be used in higher doses than in organ donors, and (3) the larynx tolerates hemodynamic instability. It was necessary to use some donors who had used addictive substances, showing that some selection criteria may be flexible. There was no conflict between thoracic surgeons and larynx surgeons. The priority always was for life-saving organs. Family consent was sometimes difficult because of the retrieval times and body donor reconstruction. The larynx surgery retrieval demanded an additional 2-5 hours during routine multiorgan donor surgery, and always the family asked about body reconstruction. The body appearance was always preserved.
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Affiliation(s)
- E Duque
- Department of Transplantation, Universidad de Antioquia, Medellín, Columbia.
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Tobin GR, Breidenbach WC, Pidwell DJ, Ildstad ST, Ravindra KV. Transplantation of the hand, face, and composite structures: evolution and current status. Clin Plast Surg 2007; 34:271-8, ix-x. [PMID: 17418676 DOI: 10.1016/j.cps.2007.01.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This article reviews the world experience in the newly emerging field of composite tissue allotransplantation. These allografts contain multiple tissues that are usually musculoskeletal structures with a skin or epithelial surface, such as hand, facial structures, larynx, tongue, ear, knee/femur, abdominal wall, and penis. They represent a new transplantation field, with only a 10-year experience and just over 50 clinical cases. This review of the 10-year world experience found uniform technical success, immunologic biology, and immunosuppression regimens very similar to solid organ transplants, and success strongly correlated with adherence to guidelines for psychiatric screening, thorough preparation of patient and families, intense postoperative monitoring, and assurance of medication access. All failures reported have been caused by lapses in these parameters. This early experience shows a great potential for application of these new procedures to the most challenging reconstructive needs.
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Affiliation(s)
- Gordon R Tobin
- Division of Plastic Surgery, Department of Surgery, University of Louisville, Louisville, KY 40292, USA.
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Barker E, Murison P, Macchiarini P, Jones A, Otto C, Rothkoetter HJ, Haverson K, Bailey M, Birchall M, Stokes C. Early immunological changes associated with laryngeal transplantation in a major histocompatibility complex-matched pig model. Clin Exp Immunol 2007; 146:503-8. [PMID: 17100771 PMCID: PMC1810420 DOI: 10.1111/j.1365-2249.2006.03232.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Laryngeal transplantation is an increasingly viable proposition for patients with irreversible diseases of the larynx. One human transplant has been performed successfully, but many questions remain before routine transplantation can begin. In order to measure the immunological changes in mismatched transplants, it is first necessary to know the immediate combined effects of ischaemia-reperfusion injury (IRI) plus the added insult of major surgery in a fully matched setting. We measured the changes in immunologically active mucosal cells following 3 h of cold ischaemia and 8 h of in situ reperfusion in a major histocompatibility complex (MHC)-matched minipig model (n = 4). Biopsies were prepared for quantitative, multiple-colour immunofluorescence histology. The number of immunologically active cells was significantly altered above (supraglottis) and below (subglottis) the vocal cords following transplantation and reperfusion (P < 0.05, P < 0.001, respectively). However, the direction of the change differed between the two subsites: cell numbers decreased post-transplant in the supraglottis and increased in the subglottis. Despite the statistical evidence for IRI, these changes were less than the large normal inter- and intrapig variation in cell counts. Therefore, the significance of IRI in exacerbating loss of function or rejection of a laryngeal allograft is open to question. Longer-term studies are required.
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Affiliation(s)
- E Barker
- Laryngeal Research Group, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK.
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Schuind F, Abramowicz D, Schneeberger S. Hand transplantation: the state-of-the-art. J Hand Surg Eur Vol 2007; 32:2-17. [PMID: 17084950 DOI: 10.1016/j.jhsb.2006.09.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 08/04/2006] [Accepted: 09/04/2006] [Indexed: 02/03/2023]
Abstract
The feasibility of hand transplantation has been demonstrated, both surgically and immunologically. Levels of immunosuppression comparable to regimens used in solid organ transplantation are proving sufficient to prevent graft loss. Many patients have achieved discriminative sensibility and recovery of intrinsic muscle function. In addition to restoration of function, hand transplantation offers considerable psychological benefits. The recipient's pre-operative psychological status, his motivation and his compliance with the intense rehabilitation programme are key issues. While the induction of graft specific tolerance represents a hope for the future, immunosuppression currently remains necessary and carries significant risks. Hand transplantation should, therefore, only be considered a therapeutic option for a carefully selected group of patients.
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Affiliation(s)
- F Schuind
- Service d'Orthopédie-Traumatologie, Cliniques Universitaires de Bruxelles, Hôpital Erasme, 808 route de Lennik, B-1070, Brussels, Belgium.
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Gordon CR, Nazzal J, Lozano-Calderan SA, Lee SGP, Lee WPA, Siemionow M, Matthews MS, Hewitt CW. From experimental rat hindlimb to clinical face composite tissue allotransplantation: Historical background and current status. Microsurgery 2006; 26:566-72. [PMID: 17091477 DOI: 10.1002/micr.20296] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The purpose of this article is to review the historical background and clinical status of composite tissue allotransplantation and to discuss the scientific evolution of clinical face transplantation. Composite tissue allotransplantation (CTA) rapidly progressed in the 1980s with the discovery of cyclosporine. Although the most success has been achieved with hand transplantation, others have made progress with allografts of trachea, peripheral nerve, flexor tendon apparatus, vascularized knee, larynx, abdominal wall, and most recently, partial face. The world's first partial face allotransplantation occurred in November 2005 in France. In April of 2006, there was a second performed in China. As of today, there are now multiple institutions with plans to attempt the world's first full facial/scalp transplant. Complete facial/scalp allotransplantation offers a viable alternative for unfortunate individuals suffering severe facial disfigurement and is a product of many decades of experimental research, beginning with rat hindlimb allografts.
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Affiliation(s)
- Chad R Gordon
- Department of Surgery, Robert Wood Johnson Medical School, Cooper University Hospital, Camden, New Jersey 08103, USA.
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