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

Objective: To explore the classification and reconstruction strategy of defects in lateral face region after operation of malignant tumors. Methods: Eighteen cases with the reconstruction of complicated defects after resection of tumors in the region of lateral face from January 2015 to January 2018 in Hunan Cancer Hospital were retrospectively reviewed. There were 14 males and 4 females, aged from 32 to 68 years. According to the presence or absence of bony scaffold, complicated defects were divided into two main categories: soft tissue perforating defects and soft tissue defects combined with bony scaffold defects. All soft tissue perforating defects in 5 cases were repaired with free anterolateral femoral flaps. Among 13 cases with soft tissue plus bony scaffold defects, 3 were repaired with free fibular flaps, 6 with free fibular flaps combined with free anterolateral femoral flaps, and 4 with chimeric deep circumflex iliac artery perforator flaps combined with anterolateral femoral flaps. Results: All flaps survived well. Two patients complicated with fistula in floor of mouth, but the wound healed after dressing change. Transoral feeding was resumed within 2 weeks after surgery in all patients. One year follow-up evaluation showed that 14 cases had symmetrical face and 10 cases had mouth opening more than 3 transverse fingers. After 36-50 months of follow-up, 6 patients died, with an overall 3-year survival rate of 66.7%. Conclusion: The classification of defects with or without bony stent loss is conducive to the overall repair design, the recovery of facial contour stent, the effective fill of dead space and the maintain of residual occlusal relationship. Good reconstruction results require a multi flap combination of osteocutaneous and soft tissue flaps.
Facial Neoplasms ; Female ; Free Tissue Flaps ; Humans ; Male ; Perforator Flap ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Thigh/surgery*

BACKGROUND: Face transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process. METHODS: A retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs. RESULTS: The patient base (n=1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (±15.3). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (±14 hours 50 minutes) and 22 hours 57 minutes (±16 hours 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%). CONCLUSIONS: When face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.
Anoxia ; Brain Death ; Brain ; Craniocerebral Trauma ; Electroencephalography ; Facial Transplantation ; Female ; Humans ; Korea ; Male ; Organ Transplantation ; Retrospective Studies ; Surgeons ; Tissue and Organ Procurement ; Tissue Donors ; Transplantation ; Transplants

OBJECTIVE: To present a case of progressive hemifacial atrophy in a young woman with Parry-Romberg Syndrome and the role of autologous fat transfer to improve her aesthetic appearance and lessen facial asymmetry.

METHODS:

Design:           Case Report

Setting:           Tertiary Government Training Hospital

Patient:           One

RESULTS: A 20-year old woman consulted because of drooping of the right eyelid and gradual thinning of right cheek muscles since age 16.  On examination, the right facial muscles were hypoplastic with prominent facial bony ridges. An MRI scan showed atrophy of the right medial pterygoid and masseter. She underwent autologous fat transfer on the right side of the face to augment the cheek, improve cosmetic appearance and lessen facial asymmetry.  

Conclusion: Our patient is satisfied and happy with the outcome and cosmetic appearance of her autologous fat transfer and is ready to undergo the same procedure if the need arises in the future. Although no definite cure exists for Parry Romberg syndrome, our report illustrates the role of autologous fat transfer as an inexpensive, easily harvested and biocompatible material to improve facial asymmetry. The procedure yielded encouraging results, although long-term benefits remain uncertain.

Keywords: Parry-Romberg syndrome; progressive hemifacial atrophy; autologous transplantation

hand caused by dichloromethane exposure were evaluated, and a literature review was done. Two healthy men aged 37 and 40 years visited our hospital with chief complaints of pain on the hands due to dichloromethane exposure. The patients had not worn protective clothing. Multiple bullae were initially noted. On the next day, fluctuation in bullae and purulent discharge were observed, and central eschar change was noted. On the 18th day after the burn, escharectomy and full-thickness skin graft were performed. Therefore, workers who use dichloromethane should wear protective clothing at workplaces. If exposed to the chemical, the worker should be instructed to do a quick wash and visit the hospital.]]>
Burns ; Burns, Chemical ; Hand ; Humans ; Inhalation ; Male ; Methylene Chloride ; Paint ; Protective Clothing ; Skin ; Skin Transplantation ; Transplants

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

Ischemia-reperfusion injury (IRI) is a major complication in liver transplantation (LT) and it is closely related to the recovery of grafts' function. Researches has verified that both innate and adaptive immune system are involved in the development of IRI and Kupffer cell (KC), the resident macrophages in the liver, play a pivotal role both in triggering and sustaining the sterile inflammation. Damage-associated molecular patterns (DAMPs), released by the initial dead cell because of the ischemia insult, firstly activate the KC through pattern recognition receptors (PRRs) such as toll-like receptors. Activated KCs is the dominant players in the IRI as it can secret various pro-inflammatory cytokines to exacerbate the injury and recruit other types of immune cells from the circulation. On the other hand, KCs can also serve in a contrary way to ameliorate IRI by upregulating the anti-inflammatory factors. Moreover, new standpoint has been put forward that KCs and macrophages from the circulation may function in different way to influence the inflammation. Managements towards KCs are expected to be the effective way to improve the IRI.
Cytokines ; Hand ; Immune System ; Inflammation ; Ischemia* ; Kupffer Cells ; Liver Transplantation* ; Liver* ; Macrophages* ; Receptors, Pattern Recognition ; Reperfusion Injury* ; Reperfusion* ; Toll-Like Receptors

A 49-year-old female patient suffered a suspicious scalding burn in her right hand and forearm during a seizure, and visited the clinic 16 hours after injury without appropriate initial treatment. The wound was covered with multiple bullae, was cold and pale, and the extension and flexion functions were decreased. The intrafascial pressure was measured as 19~95 mmHg (mean 46.9), confirming compartment syndrome. The pressure was improved following fasciotomy to 23~32 mmHg (mean 27); escharectomy, split thickness skin grafting and partial ostectomy was then performed, and an abdominal flap operation was conducted. The patient underwent a delayed procedure 14 days after the operation, and on the 18th day, subcutaneous fat and fascia tissues from the subcutaneous layer were removed from the skin; after sculpturing, split thickness skin grafting was performed. On the 21st day after flap separation, stump revisions were performed. The patient is currently undergoing rehabilitation; the metacarpophalangeal joint exhibits a normal range of motion, and the proximal interphalangeal joint has a range of motion of 30~45°. The abdominal flap operation was performed for soft tissue defects in the extensor tendon and bone exposure. Thus, various long-term processes were avoided, and by implementing a short operation time and low-cost surgery, relatively quick rehabilitation treatment could be initiated.
Burns* ; Compartment Syndromes ; Fascia ; Female ; Fingers* ; Forearm ; Hand ; Humans ; Joints ; Metacarpophalangeal Joint ; Middle Aged ; Range of Motion, Articular ; Reference Values ; Rehabilitation ; Seizures ; Skin ; Skin Transplantation ; Subcutaneous Fat ; Tendons ; Wounds and Injuries

BACKGROUND: Skin grafts are required in numerous clinical procedures, such as reconstruction after skin removal and correction of contracture or scarring after severe skin loss caused by burns, accidents, and trauma. The current standard for skin defect replacement procedures is the use of autologous skin grafts. However, donor-site tissue availability remains a major obstacle for the successful replacement of skin defects and often limits this option. The aim of this study is to effectively expand full thickness skin to clinically useful size using an automated skin reactor and evaluate auto grafting efficiency of the expanded skin using Yucatan female pigs. METHODS: We developed an automated bioreactor system with the functions of real-time monitoring and remote-control, optimization of grip, and induction of skin porosity for effective tissue expansion. We evaluated the morphological, ultra-structural, and mechanical properties of the expanded skin before and after expansion using histology, immunohistochemistry, and tensile testing. We further carried out in vivo grafting study using Yucatan pigs to investigate the feasibility of this method in clinical application. RESULTS: The results showed an average expansion rate of 180%. The histological findings indicated that external expansion stimulated cellular activity in the isolated skin and resulted in successful grafting to the transplanted site. Specifically, hyperplasia did not appear at the auto-grafted site, and grafted skin appeared similar to normal skin. Furthermore, mechanical stimuli resulted in an increase in COL1A2 expression in a suitable environment. CONCLUSION: These findings provided insight on the potential of this expansion system in promoting dermal extracellular matrix synthesis in vitro. Conclusively, this newly developed smart skin bioreactor enabled effective skin expansion ex vivo and successful grafting in vivo in a pig model.
Bioreactors ; Burns ; Cicatrix ; Contracture ; Extracellular Matrix ; Female ; Hand Strength ; Humans ; Hyperplasia ; Immunohistochemistry ; In Vitro Techniques ; Methods ; Models, Animal ; Porosity ; Skin Transplantation ; Skin* ; Swine ; Tissue Expansion ; Tissue Expansion Devices ; Transplants

Antibody-mediated rejection (AMR) is a major complication after ABO-incompatible liver transplantation. According to the 2016 Banff Working Group on Liver Allograft Criteria for the diagnosis of acute AMR, a positive serum donor specific antibody (DSA) is needed. On the other hand, the clinical significance of the histological findings of AMR in the absence of DSA is unclear. This paper describes a 57-year-old man (blood type, O+) who suffered from hepatitis B virus cirrhosis with hepatocellular carcinoma. Pre-operative DSA and cross-matching were negative. After transplantation, despite the improvement of the liver function, acute AMR was observed in the protocol biopsy on postoperative day 7; the cluster of differentiation 19+ (CD19+) count was 0% and anti-ABO antibody titers were 1:2. This paper presents the allograft injury like AMR in the absence of DSA after ABOi living donor liver transplantation with low titers of anti-ABO antibody and depleted serum CD19+ B cells.
Allografts ; Antibody-Dependent Cell Cytotoxicity ; B-Lymphocytes ; Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Fibrosis ; Hand ; Hepatitis B virus ; HLA Antigens ; Humans ; Liver Transplantation* ; Liver* ; Living Donors ; Middle Aged ; Tissue Donors*