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

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

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

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

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

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

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

composite tissues allotransplantation (CTA), such as heteregeneous or non-organ tissues, possible in humans. CTA has evolved dramatically since the first successful rat hind limb allotransplantation. Numerous clinical applications including face, 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

PURPOSE: Composite tissue allotransplantation has emerged as a new therapeutic modality to reconstruct major tissue defects of the head, neck and extremities. A questionnaire-based instrument, the Louisville Instrument for Transplantation(LIFT), has been developed to objectively assess the risk-versus-benefit ratio for composite tissue allotransplantation procedures. The objective of this study is to assess if the LIFT is a useful, reliable and valid tool to apply to the Korean population. METHODS: Seventy-three medical students and 60 lay public completed the LIFT questionnaire(translated to Korean) over the period from February 2010 to April 2010. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was analyzed using Pearson's correlation coefficient. Construct validity was assessed by comparing Pearson's correlation coefficients between perceived improvements in quality of life and responses to risk tolerance questions concerning organ transplants. RESULTS: Measurements of the test-retest reliability showed that Pearson's correlation coefficients ranged from 0.241 to 0.902, and Cronbach's alphas ranged from 0.52 to 0.80 for medical students and from 0.63 to 0.83 for the lay public. Pearson's correlation coefficients showed significant correlations between perceived improvements in quality of life and responses to risk tolerance questions concerning organ transplants. Hand transplant showed a significant correlation in medical students. Foot, hand, two hands, larynx, partial face transplants showed significant correlations for the lay public. CONCLUSION: The applicability of the LIFT to the Korean population was found to be reliable and valid. The LIFT may serve as a useful tool for clinical application in the Korean population.
Extremities ; Facial Transplantation ; Foot ; Hand ; Head ; Humans ; Larynx ; Neck ; Quality of Life ; Reproducibility of Results ; Students, Medical ; Transplants

No abstract available.
Facial Transplantation*