Face ; surgery ; Hand Transplantation ; Humans ; Organ Transplantation ; Transplantation, Homologous

OBJECTIVETo study the psychology and the treatment during the process of hand allograft.

METHODSThe patients were interviewed to evaluate their states of mind and their abilities to manage stress during the selection of patients. The psychology of the two patients were trained before the operation and managed accordingly afterwards.

RESULTSOne of 12 candidates was found to be unsuitable for the transplantation because of psychiatric problems. One week postoperatively, the two patients were anxious, lacked patience and were afraid of seeing the long-awaited grafted hand. After 1 week, the patients began to accept the new hand, with full acceptance of the hand 1 month later. With the recovery of hand sensation 4 to 5 months after the operation, the patients regarded the hand as their own.

CONCLUSIONPsychological problems exist during preoperative selection of patients and postoperative rehabilitation, requiring psychologists in the hand transplantation team.

Adult ; Female ; Hand Transplantation ; Humans ; Psychotherapy ; Transplantation ; psychology ; Transplantation, Homologous

PURPOSE: The objective of this study was to evaluate clinical results of dual miniplate fixation for comminuted or periarticular fractures of the hand. MATERIALS AND METHODS: Twenty cases in 18 patients who had comminuted or periarticular fractures of metacarpal or phalangeal bones were treated with dual miniplate fixation from April, 2007 to May, 2009. The mean followed up period was 14.7 months. Our study included comminuted or periarticular fractures which were difficult to keep the fixation by pining or single plating. We evaluated radiologic bony union, angular or rotational deformity, extensor tendon irritaion and total arc of motion. RESULTS: Bony union was achieved successfully after primary dual miniplate fixationin in 12 cases. In 7 cases with a nonunion following previous operative fixation, bony union was obtained by dual miniplate fixation and bone grafting. In one case who had received primary dual plate fixation, nonunion occurred due to massive bone defect. Bony union was obtained by secondary dual plate fixation and bone grafting. Postoperative rotational deformity, angular deformity and irritation symptom were not observed in all cases. Functionally acceptable range of active motion was restored by way of early active motion. CONCLUSION: The dual miniplate fixation is one of the useful method for comminuted metacarpal or phalangeal fractures which cannot obtain firm fixation by other methods.
Bone Transplantation ; Congenital Abnormalities ; Fractures, Comminuted ; Hand ; Humans ; Tendons

When faced with an irrepairable meniscus or a patient who has had a total or subtotal meniscectomy, meniscus allograft transplantation (MAT) is the preferred modality to restore biomechanical function of the meniscus. The indications for meniscus allograft transplantation are yet to be established. However, currently, MAT has previously been indicated for symptomatic patients who have mild or early osteoarthritis, are younger than 50 years of age, and present with an Outerbridge grade II or lower. The short- to intermediate-term results confirmed noteworthy clinical improvements and consistent objective findings. On the other hand, the successful outcome would be reduced by various complications. Therefore, long-term observation required to evaluate the longevity of these results. The purpose of this article is to review the current research of concerns on the results of MAT, and to describe the technical tips and pitfalls so as to successful clinical results.
Hand ; Humans ; Knee ; Longevity ; Osteoarthritis ; Transplantation, Homologous ; Transplants

OBJECTIVETo observe the survival of hand allograft under the state of immunosuppression and the pathological changes of rejection in the recovery process.

METHODSThe biopsies of the skin, nerve, muscle, tendon and bone tissue of hand allografts during different stages from 1 day to 7 months after operation were observed using routine histological technique.

RESULTSNo significant changes due to rejection in skin, nerve, muscle and bone tissue were observed. But different degrees of weak rejective changes were found on the wall of blood vessels; in the muscle and nerve the reactions were markedly stronger than those found in skin tissues.

CONCLUSIONSThe rejection in deep tissues should be monitored in controlling the rejection of hand allograft.

Adult ; Biopsy ; Graft Rejection ; pathology ; Hand Transplantation ; Humans ; Immunosuppression ; Male ; Skin ; immunology ; pathology ; Transplantation, Homologous

The world's first face transplantation was performed in France, in 2005. Since then, 21 cases of face transplantation have been performed. Face transplantation is one of the most prominent part of composite tissue allotransplantation (CTA) along with hand transplantation. Since these fields are not deal with life-saving organs, there are many arguments about immunosuppression therapy. Recent paradigm of face transplantation shows that surgical ranges are expanded from partial face transplantation to full face transplantation. Most immunosuppression protocols are triple therapy, which consists of tacrolimus (FK-506), mycophenolate mofetil and prednisolone. Anatomical researches, immunosuppression, and immunotolerance take great parts in the researches of CTA. The medical fields directly related to face transplantation are microsurgery, immunology, and transplantation. Nowadays, each field is performed widely. Therefore people, even medical teams think face transplantation could be easily realized, sooner or later. But there are lots of things that should be prepared for not only practice and immunosuppression therapy but also for the cooperation with relevant fields. That's the reason why only 21 cases of face transplantation have been done, while more than 70 cases of hand transplantation have been done in the past years. Especially in Korea, brain death patients are not enough even for organ transplantation and furthermore there are some troubles in taking part in the society of transplantation. Face transplantation has lots of problems concerning variable medical fields, administration, society, ethics, and laws. Therefore, for the realization of face transplantation in Korea, not only medical skills but also political powers are needed.
Brain Death ; Facial Transplantation ; France ; Hand ; Humans ; Immune Tolerance ; Immunosuppression ; Jurisprudence ; Korea ; Microsurgery ; Mycophenolic Acid ; Organ Transplantation ; Prednisolone ; Tacrolimus ; Transplants

The purpose of this study was to explore the change of muscle strength, muscle endurance, flexibility and activities of daily living to develop a rehabilitational program. The subjects were selected randomly among the patients who underwent kidney transplantations at one major transplantation hospital in Seoul, Korea. This study was carried out between November 23, 1999 and February 15, 2000. The subjects in this study consisted of 16 patients who had kidney transplantations between 1 month and 12 months ago prior to this study. They were all on steroids and did not take any physical exercise regularly. The muscle strength, muscle endurance, flexibility and activities of daily living were evaluated at 1st week and after 12 weeks. The data were analyzed with numbers, percentiles, mean, standard deviation and t-test. The results were as follows: 1. After 12 weeks, the grip strength was significantly decreased than 1st week (p=.0002). 2. After 12 weeks, the back lift strength was significantly decreased than 1st week (p=.0002). 3. After 12 weeks, the muscle endurance was increased than 1st week, but it was not significant(p=.5487). After 12 weeks, the flexibility was significantly decreased than 1st week (p=.0002). 5. After 12 weeks, the activities of daily living was significantly decreased than 1st week (p=.0006). Like the above result, the kidney transplant receipients' muscle strength, flexibility and activities of daily living were reduced. In order to solve this problem, the writer has found that program development to prevent the defects should be extremely required. Since now on the number of patients should expand. After the kidney transplantation, the periods of 4, 8, 12 and 16 weeks are extended. The writer proposes to examine the different phase of change in each periods.
Activities of Daily Living* ; Exercise ; Hand Strength ; Humans ; Kidney Transplantation ; Kidney* ; Korea ; Muscle Strength* ; Pliability* ; Program Development ; Seoul ; Steroids ; Transplantation*

hand, trachea, larynx, and vascularized joint have been performed. Although composite tissue allografts are still in their infancy, they have opened a new era in the field of transplantation surgery and pathology, so that maxillofacial reconstructive surgeons may occasionally be faced with the challenge of diagnosing skin refection of a composite tissue allograft. Facial allotransplantation (FAT) is a new surgical technique that could be considered as a new paradigm in facial reconstruction. Since the first human FAT had been achieved in 2005, 17 cases have been reported in the world up to date. However, many problems such as life-long immunosuppression, immune rejection, ethical problems and psychological problems are remained, so facial CTA is new reconstructive option with no general acceptance. The authors reviewed the indications, the results of 17 cases and their complications, and additional consideration factors in this article, and intended to raise the awareness of oral and maxillofacial surgeons in this type of facial transplantation.]]>
Animals ; Extremities ; Facial Transplantation ; Hand ; Humans ; Immunosuppression ; Joints ; Larynx ; Rats ; Rejection (Psychology) ; Skin ; Trachea ; Transplantation, Homologous ; Transplants

The purpose of this study was to evaluate the tissue response in various bone grafting materials, especially xenogenous bone materials in vivo, compare of bone formation capacity of various bone grafting materials on rat skull defects and evaluate the effect of Hyaluronic acid on healing of human Demineralized Freezed Dried Bone allogenous graft (DFDBA) materials in rat calvarial defects. 30 Sprague-Dawly rats were divided into 4 groups. 7 X 7 mmsize bony defect were artificially prepared in the calvaria (both parietal bone) of all 30 rats and follwed group grafting of autogenous bone graft on right side and allogenic DFDBA on left side bone graft (rat DFDB) in 15 control group, but in 15 experimental group, xenograft (human DFDB) on left side, hyaluronic acid treated with xenograft on right side. Sequential sacrifices was performed at 1, 2, 4, 6, 8 weeks of experiment. These specimens were stained with HandE and MT stain, and then histologic analysis under light microscope was carried out. There were inflammatory reaction in all graft material during early stage. Autogenous and Allogenous DFDBA graft group observed inflammatory reaction at 1 week. Xenograft group persistant inflammatory reaction until 4 weeks, but in HA treated xenograft group inflammatory reaction was decreased at 2 weeks. Osteoblastic activity in control group was begun at 2 week, xenograft group was delayed at 6 weeks, however HA treated xenograft group was begun at 4 weeks. At 2 week, mild osteoclastic activity were observed in all xenograft group not in concerned to HA, but there was no difference each group after 4 weeks. There are most activated angiogenesis around graft mateirals in xenograft group at 2 weeks, but in HA treated xenograft group, decreased angiogenesis was observed at same time. Bone formation and bone maturation of xenograft group, there was no difference in HA treatment, was less than control group. Fibrosis around xenograft materials were observed until 6 weeks, there was no difference between xenograft and HA treated groups.
Animals ; Bone Transplantation ; Fibrosis ; Hand ; Heterografts* ; Humans ; Hyaluronic Acid* ; Osteoblasts ; Osteoclasts ; Osteogenesis ; Rabeprazole ; Rats* ; Skull ; Transplants

PURPOSE: Procuring the left liver lobe plus the caudate lobe was originally done in an effort to increase the graft mass itself. However, there has been some controversy about the procedure's effectiveness. We investigated the effect of concomitant caudate lobe transplantation and fates of the implanted caudate lobe. METHODS: From January 2002 to December 2003, 290 cases of living donor liver transplantation (LDLT) were performed at our institution. Among them, there was 31 case of adult-to-adult LDLT using a left lobe plus the caudate lobe. The volumes of left lobe and caudate lobe were measured separately by using computed tomogram (CT) volumetry. The operation time for the concomitant caudate lobe procurement took an average of an additional 30 minutes over the routine left lobe procurement because of the dissection of the retrohepatic vena cava. There was no separate caudate duct in the 31 consecutive grafts in this series. RESULTS: The graft weight of the left lobe plus the caudate lobe was 455+/-55 gm, yielding a mean graft-recipient weight ratio of 0.79+/-0.11. Volumetry of the preoperative donor CT scan revealed that the volume of the caudate lobe was 24+/-6 ml, which was equivalent to 5% of the left lobe volume. We prepared the largest single caudate vein with a caval patch and then reconstructed it in 24 recipients. The regeneration rate of the caudate lobe after transplantation was 116% after 1 week and 121% after 1 month. On the other hand, the regeneration rate of the left lobe was 193% after 1 week and 227% after 1 month. The regeneration rate for the left lobe was greater than that for the caudate lobe. 29 of the 31 recipients survived. CONCLUSION: We think that increasing the graft mass by 5% justifies to performing the concomitant caudate lobe procurement at the expense of 30-minute's effort.
Hand ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Regeneration ; Tissue Donors ; Tomography, X-Ray Computed ; Transplants* ; Veins