Innovations in reconstructive microsurgery: Reconstructive transplantation

Kollar, Branislav; Tasigiorgos, Sotirios; Dorante, Miguel I.; Carty, Matthew J.; Talbot, Simon G.; Pomahac, Bohdan

doi:10.1002/jso.25147

Cited by 18 publications

(8 citation statements)

References 79 publications

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“…Vascularized composite allotransplantation (VCA) such as face and upper extremity (UE) transplantation can successfully restore form and function to patients with devastating injuries (1, 2). However, the transplantation of such complex tissues is associated with high rates of acute rejection (AR), reaching an incidence of more than 80% in the first postoperative year (3).…”

Section: Introductionmentioning

confidence: 99%

MMP3 Is a Non-invasive Biomarker of Rejection in Skin-Bearing Vascularized Composite Allotransplantation: A Multicenter Validation Study

et al. 2019

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Background: There is unmet need for non-invasive immunomonitoring to improve diagnosis and treatment of acute rejection in vascularized composite allotransplantation (VCA). Circulating matrix metalloproteinase 3 (MMP3) was described as a candidate non-invasive biomarker to predict treatment response to acute rejection in clinical VCA. However, larger validation studies are yet to be reported to allow for more definitive conclusions.Methods: We retrospectively measured MMP3 levels using ELISA in a total of 140 longitudinal serum samples from six internal and three external face transplant recipients, as well as three internal and seven external upper extremity transplant recipients. The control groups comprised serum samples from 36 kidney transplant recipients, 14 healthy controls, and 38 patients with autoimmune skin disease. A linear mixed model was used to study the effect of rejection state (pre-transplant, no-rejection, non-severe rejection (NSR), and severe rejection) on MMP3 levels.Results: In VCA, MMP3 levels increased significantly (p < 0.001) between pre- and post-transplant no-rejection states. A further increase occurred during severe rejection (p < 0.001), while there was no difference in MMP3 levels between non-severe and no-rejection episodes. A threshold of 5-fold increase from pre-transplant levels could discriminate severe from NSR with 76% sensitivity and 81% specificity (AUC = 0.79, 95% CI = 0.65–0.92, p < 0.001). In kidney transplantation, the MMP3 levels were significantly (p < 0.001) elevated during antibody-mediated rejection but not during T-cell mediated rejection (TCMR) (p = 0.547). MMP3 levels in healthy controls and autoimmune skin disease patients were comparable with either pre-transplant or no-rejection/NSR episodes of VCA patients.Conclusion: The results of this study suggest that serum MMP3 protein is a promising marker for stratifying patients according to severity of rejection, complementary to biopsy findings.

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Section: Introductionmentioning

confidence: 99%

MMP3 Is a Non-invasive Biomarker of Rejection in Skin-Bearing Vascularized Composite Allotransplantation: A Multicenter Validation Study

et al. 2019

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“…Since the first allogenic face transplant was first performed in 2005, 1 over 40 cases have been performed worldwide and this currently serves as an exemplar for restoration of both form and function in severely disfigured individuals (eg, following gunshot injuries). 8 Face transplants for the first time allowed us to restore both function and form in the aesthetic sense. However, with the longer follow-up accorded more than a decade later, its limitations, namely immunosuppression, 9 death, 10 and increasing cost implications, 11 have put the initial euphoria on hold and forced reconstructive surgeons to reflect on the indications for face transplants more carefully.…”

Section: Discussionmentioning

confidence: 99%

Facial Nerve Revascularization Strategies in Facial Restoration

Khajuria

Bisase

Norris

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Facial transplants represent the current exemplar in the reconstruction of severely damaged faces, whereas conventional free flap reconstruction has its limitations in restoring both function and surface cover. Methods: In a retrospective study over 6 years (2014–2020), 5 cases (n = 5) of vascularized nerve flaps (VNFs) were performed by our team. These involved three acute and two late reconstructions. The mean age was 41 years with a maximum of 6-year follow-up. To objectify the different permutations and combinations, we categorized composite, chimeric, and hybrid VNFs into types I, IIa-c, and III, each with a unique characteristic. Postoperative function was evaluated using the validated Sunnybrook and Terzis scores for facial nerve palsy; masticatory function was assessed using dental impression studies. Results: There was a 100% flap survival rate, with no instances of flap necrosis and only one complication: hematoma at 24 hours postoperative. Sunnybrook and Terzis scores showed a statistically significant improvement postoperatively, indicating both improved repose and facial expressions (paired student t test, P < 0.05). Given that each VNF was specifically customized for a particular patient, each type of VNF in this cohort was unique, thereby illustrating each type succinctly. Conclusions: VNFs are separate entities from standard free flaps, as they require extensive preoperative planning to allow the deconstructing of composite blocks of tissue into separate vascularized entities and amalgamating them into a new conglomerate. This allows VNFs to fill a niche area in facial reconstructive surgery between face transplants and conventional free tissue transfers, with enormous potential.

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“…Reconstructive transplantation such as face transplantation (FT) is a promising way to restore the functionality and social reintegration for severely disfigured patients 1,2 . More than forty such procedures have been performed world-wide to date 3 .…”

Section: Background and Summarymentioning

confidence: 99%

Blood proteome profiling using aptamer-based technology for rejection biomarker discovery in transplantation

et al. 2019

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Face transplantation is a promising solution for patients with devastating facial injuries who lack other satisfactory treatment options. At the same time, this type of transplantation is accompanied with high risks of acute transplant rejection. The limitations of traditional skin biopsy and the need to frequently monitor the condition of face transplant call for less invasive biomarkers to better diagnose and treat acute rejection. Discovery of peripheral serum proteins accurately reflecting the transplant status would represent a reasonable solution to meet this demand. However, to date, there is no clinical data available to address the feasibility of this approach. In this study, we used the next generation aptamer-based SOMAscan proteomics platform to profile 1305 proteins of peripheral blood serum in twenty-four samples taken from 6 patients during no-rejection, nonsevere rejection, and severe rejection episodes. Also, we provide a detailed description of biosample processing and all steps to generate and analyze the SOMAscan dataset with hope it will assist in performing biomarker discovery in other transplantation centers using this platform.

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Innovations in reconstructive microsurgery: Reconstructive transplantation

Cited by 18 publications

References 79 publications

MMP3 Is a Non-invasive Biomarker of Rejection in Skin-Bearing Vascularized Composite Allotransplantation: A Multicenter Validation Study

MMP3 Is a Non-invasive Biomarker of Rejection in Skin-Bearing Vascularized Composite Allotransplantation: A Multicenter Validation Study

Facial Nerve Revascularization Strategies in Facial Restoration

Blood proteome profiling using aptamer-based technology for rejection biomarker discovery in transplantation

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