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A Modified Heterotopic Swine Hind Limb Transplant Model for Translational Vascularized Composite Allotransplantation (VCA) Research

Vascularized Composite Allotransplantation (VCA) such as hand and face transplants represent a viable treatment option for complex musculoskeletal trauma ...

Johns Hopkins University School of Medicine

Incisions made perpendicular to the hair follicles during anterior frontal hairline brow lifts or forehead shortening procedures help produce an inconspicuous forehead scar. The success of this "hidden" incision relies on the anteriorly directed frontal hairline follicles and their growth vector. The authors hypothesized that a similar incision could be made perpendicular to the hair follicles in the temple region during rhytidectomy. A well-designed anterior hairline beveled incision over the temple would allow for improved leverage during soft-tissue repositioning and a concealed hairline incision in the temple region.

Follicular anatomy of the anterior temporal hairline and implications for rhytidectomy.

Composite tissue allografting may be an ideal solution to many problems requiring reconstructive surgery. Unfortunately, complications associated with chronic immunocompromise are major impediments to widespread use of composite tissue allografting. Current immunosuppressive and immunomodulatory paradigms focus on modification of the recipient through global immunosuppression or donor/recipient chimerism. Alternatively, modifying the allograft to block rejection or promote tolerance could confine deleterious immunosuppressive effects to the graft or eliminate graft rejection. However, a technique introducing genetic information into the transplant is needed. The authors demonstrate the first model for expressing a gene of interest locally in a hind-limb transplant.

Transgene expression in a model of composite tissue allotransplantation.

Epinephrine in digital blocks has been condemned by traditional medical theory. The authors provide a retrospective review of 1111 cases involving digital block anesthesia with epinephrine in conjunction with an extensive literature review.

Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases.

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Discusi&#xF3;n: El Programa de Mujeres Brigham y Hospital de la cara de Trasplantes: una mirada retrospectiva

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Discussion: The Brigham and Women's Hospital face transplant program: a look back.

Discussion: Le Programme de Brigham et des femmes de l&#x26;#39;H&#xF4;pital de greffe du visage: un Look Back

Diskussion: Die Brigham and Women&#39;s Hospital Gesicht transplant Program: ein Blick zur&uuml;ck.

Discussione: Il Brigham e ospedale femminile faccia programma trapianto: uno sguardo indietro.

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To minimize maintenance immunosuppression in upper-extremity transplantation to favor the risk-benefit balance of this procedure.

Upper-extremity transplantation using a cell-based protocol to minimize immunosuppression.

Successful microvascular replantation of amputated facial tissues has been sporadically reported in the literature, although most of these reports have concerned the reattachment of relatively small and segmental portions of the nose or nasal tip. We report the successful replantation of a traumatically amputated composite piece of tissue comprising the entire nose, most of the upper and lower lips, and the nasal boney and cartilaginous complex based on microvascular repair of the labial arteries and glabellar veins and discuss the results and implications of this experience.

Successful replantation of an amputated midfacial segment: technical details and lessons learned.

Wider application of vascularized composite allotransplantation (VCA) is limited by the need for chronic immunosuppression. Recent data suggest that the lymphatic system plays an important role in mediating rejection. This study used near-infrared (NIR) lymphography to describe lymphatic reconstitution in a rat VCA model. Syngeneic (Lewis-Lewis) and allogeneic (Brown Norway-Lewis) rat orthotopic hind limb transplants were performed without immunosuppression. Animals were imaged pre- and postoperatively using indocyanine green (ICG) lymphography. Images were collected using an NIR imaging system. Co-localization was achieved through use of an acrylic paint/hydrogen peroxide mixture. In all transplants, ICG first crossed graft suture lines on postoperative day (POD) 5. Clinical signs of rejection also appeared on POD 5 in allogeneic transplants, with most exhibiting Grade 3 rejection by POD 6. Injection of an acrylic paint/hydrogen peroxide mixture on POD 5 confirmed the existence of continuous lymphatic vessels crossing the suture line and draining into the inguinal lymph node. NIR lymphography is a minimally invasive imaging modality that can be used to study lymphatic vessels in a rat VCA model. In allogeneic transplants, lymphatic reconstitution correlated with clinical rejection. Lymphatic reconstitution may represent an early target for immunomodulation.

Near-infrared lymphography as a minimally invasive modality for imaging lymphatic reconstitution in a rat orthotopic hind limb transplantation model.

Abdominal wall vascularized composite allotransplantation (AW-VCA) is a rarely utilized technique for large composite abdominal wall defects. The goal of this article is to systematically review the literature and current concepts of AW-VCA, outline the challenges ahead, and provide an outlook for the future.

Article	Year
Follicular anatomy of the anterior temporal hairline and implications for rhytidectomy. Plastic and reconstructive surgery\| PubMed ID: 17440370	2007
Transgene expression in a model of composite tissue allotransplantation. Plastic and reconstructive surgery\| PubMed ID: 20009792	2010
Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plastic and reconstructive surgery\| PubMed ID: 20697319	2010
Discussion: The Brigham and Women's Hospital face transplant program: a look back. Plastic and reconstructive surgery\| PubMed ID: 22186588	2012
Upper-extremity transplantation using a cell-based protocol to minimize immunosuppression. Annals of surgery\| PubMed ID: 23001085	2013
Successful replantation of an amputated midfacial segment: technical details and lessons learned. Annals of plastic surgery\| PubMed ID: 23241762	2013
Near-infrared lymphography as a minimally invasive modality for imaging lymphatic reconstitution in a rat orthotopic hind limb transplantation model. Transplant international : official journal of the European Society for Organ Transplantation\| PubMed ID: 23879384	2013
Current concepts and systematic review of vascularized composite allotransplantation of the abdominal wall. Clinical transplantation\| PubMed ID: 24102820	2013

Damon S. Cooney

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