Perceived Success in Upper-Extremity Vascularized Composite Allotransplantation: A Qualitative Study

Abstract Background Tendon transfer in the upper extremity represents a powerful tool in the armamentarium of a reconstructive surgeon in the setting of irreparable nerve injury or the anatomic loss of key portions of the muscle-tendon unit. The concept uses the redundancy/expendability of tendons by utilizing a nonessential tendon to restore the function of a lost or nonfunctional muscle-tendon unit of the upper extremity. This article does not aim to perform a comprehensive review of tendon transfers. Instead it is meant to familiarize the reader with salient historical features, common applications in the upper limb, and provide the reader with some technical tips, which may facilitate a successful tendon transfer. Learning Objectives (1) Familiarize the reader with some aspects of tendon transfer history. (2) Identify principles of tendon transfers. (3) Identify important preoperative considerations. (4) Understand the physiology of the muscle-tendon unit and the Blix curve. (5) Identify strategies for setting tension during a tendon transfer and rehabilitation strategies. Design This study was designed to review the relevant current literature and provide an expert opinion. Conclusions Tendon transfers have evolved from polio to tetraplegia to war and represent an extremely powerful technique to correct neurologic and musculotendinous deficits in a variety of patients affected by trauma, peripheral nerve palsies, cerebral palsy, stroke, and inflammatory arthritis. In the contemporary setting, these very same principles have also been very successfully applied to vascularized composite allotransplantation in the upper limb.

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Evolution of the rat hind limb transplant as an experimental model of vascularized composite allotransplantation: Approaches and advantages

SAGE Open Medicine ◽

10.1177/2050312120968721 ◽

2020 ◽

Vol 8 ◽

pp. 205031212096872

Author(s):

Yoram Y Fleissig ◽

Jason E Beare ◽

Amanda J LeBlanc ◽

Christina L Kaufman

Keyword(s):

Upper Extremity ◽

Hind Limb ◽

Large Body ◽

Surgical Techniques ◽

Experimental Models ◽

Tissue Loss ◽

Large Animal ◽

Solid Organ ◽

Vascularized Composite Allotransplantation ◽

Large Animal Models

As clinical experience with surgical techniques and immunosuppression in vascularized composite allotransplantation recipients has accumulated, vascularized composite allotransplantation for hand and face have become standard of care in some countries for select patients who have experienced catastrophic tissue loss. Experience to date suggests that clinical vascularized composite allotransplantation grafts undergo the same processes of allograft rejection as solid organ grafts. Nonetheless, there are some distinct differences, especially with respect to the immunologic influence of the skin and how the graft is affected by environmental and traumatic insults. Understanding the mechanisms around these similarities and differences has the potential to not only improve vascularized composite allotransplantation outcomes but also outcomes for all types of transplants and to contribute to our understanding of how complex systems of immunity and function work together. A distinct disadvantage in the study of upper extremity vascularized composite allotransplantation recipients is the low number of clinical transplants performed each year. As upper extremity transplantation is a quality of life rather than a lifesaving transplant, these numbers are not likely to increase significantly until the risks of systemic immunosuppression can be reduced. As such, experimental models of vascularized composite allotransplantation are essential to test hypotheses regarding unique characteristics of graft rejection and acceptance of vascularized composite allotransplantation allografts. Rat hind limb vascularized composite allotransplantation models have been widely used to address these questions and provide essential proof-of-concept findings which can then be extended to other experimental models, including mice and large animal models, as new concepts are translated to the clinic. Here, we review the large body of rat hind limb vascularized composite allotransplantation models in the literature, with a focus on the various surgical models that have been developed, contrasting the characteristics of the specific model and how they have been applied. We hope that this review will assist other researchers in choosing the most appropriate rat hind limb transplantation model for their scientific interests.

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A Provider Perspective of Psychosocial Predictors of Upper-Extremity Vascularized Composite Allotransplantation Success

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2021.05.005 ◽

2021 ◽

Author(s):

Sarah E. Kinsley ◽

Emma E. Williams ◽

Nora K. Lenhard ◽

Sejal B. Shah ◽

Robert R. Edwards ◽

...

Keyword(s):

Upper Extremity ◽

Psychosocial Predictors ◽

Vascularized Composite Allotransplantation ◽

Provider Perspective

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Upper extremity and craniofacial vascularized composite allotransplantation: ethics and immunosuppression

Emerging Topics in Life Sciences ◽

10.1042/etls20190060 ◽

2019 ◽

Vol 3 (6) ◽

pp. 681-686

Author(s):

James Benedict ◽

Gerard Magill

Keyword(s):

Upper Extremity ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Vascularized Composite Allotransplantation ◽

Medium Term ◽

Term Survival ◽

Ethical Concerns ◽

History Of ◽

Late Twentieth ◽

Late Twentieth Century

Vascularized composite allotransplantation (VCA) is the name most often used to refer to the transplantation of anatomical units composed of multiple tissue types (skin, bone, muscle, tendon, nerves, vessels, etc.) when such transplants do not have the primary purpose of extending life, as is the case in the more familiar field of solid organ transplantation (SOT). A serious interest in VCA developed in the late twentieth century following advances in immunosuppression which had led to significant improvements in short and medium-term survival among SOT recipients. Several ethical concerns have been raised about VCA, with many being connected in one way or another to the limitations, burdens, and risks associated with immunosuppression. This article will focus on upper extremity and craniofacial VCA, beginning with a brief review of the history of VCA including reported outcomes, followed by a discussion of the range of ethical concerns, before exploring in greater detail how immunological issues inform and shape several of the ethical concerns.

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Pediatric Upper Extremity Vascularized Composite Allotransplantation

10.1201/9780429260179-5 ◽

2021 ◽

pp. 75-97

Author(s):

Kevin J. Zuo ◽

Anna Gold ◽

Randi Zlotnik Shaul ◽

Emily S. Ho ◽

Gregory H. Borschel ◽

...

Keyword(s):

Upper Extremity ◽

Vascularized Composite Allotransplantation

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Qualitative study on “hydropic degeneration” of The hepatocytes in viral hepatitis

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010016039x ◽

1990 ◽

Vol 48 (3) ◽

pp. 568-569

Author(s):

Le Meizhao ◽

Ye Ming ◽

Song Xiaoming ◽

Xu Jiazhang

Keyword(s):

Qualitative Study ◽

Viral Hepatitis ◽

Chronic Active Hepatitis ◽

Microscopic Observation ◽

Hydropic Degeneration ◽

Light Microscopic Observation ◽

Biopsy Specimens ◽

Endoplasm Reticulum ◽

Mixed Fluid ◽

Peripheral Cytoplasm

“Hydropic degeneration” of the hepatocytes are often found in biopsy of the liver of some kinds of viral hepatitis. Light microscopic observation, compareted with the normal hepatocytes, they are enlarged, sometimes to a marked degree when the term “balloning” degeneration is used. Their cytoplasm rarefied, and show some clearness in the peripheral cytoplasm, so, it causes a hydropic appearance, the cytoplasm around the nuclei is granulated. Up to the present, many studies belive that main ultrastructural chenges of hydropic degeneration of the hepatocytes are results of the RER cristae dilatation with degranulation and disappearance of glycogen granules.The specimens of this study are fixed with the mixed fluid of the osmium acidpotassium of ferricyanide, Epon-812 embed. We have observed 21 cases of biopsy specimens with chronic severe hepatitis and severe chronic active hepatitis, and found that the clear fields in the cytoplasm actually are a accumulating place of massive glycogen. The granules around the nuclei are converging mitochondria, endoplasm reticulum and other organelles.

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A qualitative study of the PBL Dental Clinic at the University of Southern California

Journal of Dental Education ◽

10.1002/j.0022-0337.1998.62.9.tb03229.x ◽

1998 ◽

Vol 62 (9) ◽

pp. 660-665

Author(s):

HA Wang

Keyword(s):

Qualitative Study ◽

Southern California ◽

University Of Southern California ◽

Dental Clinic ◽

The University

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American Speech-Language Pathologists' Training and Legislative Knowledge When Working With Immigrant and Refugee Populations: A Qualitative Study

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig17-2019-0028 ◽

2019 ◽

Vol 4 (5) ◽

pp. 1148-1161

Author(s):

Camilo Maldonado ◽

Alejandro Ashe ◽

Kerri Bubar ◽

Jessica Chapman

Keyword(s):

Qualitative Study ◽

Service Provision ◽

Limited English Proficiency ◽

Linguistic Diversity ◽

Speech Language Pathologists ◽

Federal Mandates ◽

Refugee Families ◽

Provision Of Services ◽

English Speaking ◽

Immigrant And Refugee

Background American educational legislation suggests culturally competent speech and language services should be provided in a child's native language, but the number of multilingual speech-language pathologists (SLPs) is negligible. Consequently, many monolingual English-speaking practitioners are being tasked with providing services to these populations. This requires that SLPs are educated about cultural and linguistic diversity as well as the legislation that concerns service provision to non-English or limited English proficiency speakers. Purpose This qualitative study explored the experiences of monolingual, American, English-speaking SLPs and clinical fellows who have worked with immigrant and refugee families within a preschool context. It investigated what training SLPs received to serve this population and what knowledge these SLPs possessed with regard to federal legislation governing the provision of services to culturally and linguistically diverse (CLD) communities. Method Ten American clinicians with experience treating CLD children of refugee and immigrant families in the context of preschool service provision participated in the study. Semistructured interviews were utilized to better understand the type of training clinicians received prior to and during their service delivery for CLD populations. Additionally, questions were asked to explore the degree to which practitioners understood federal mandates for ethical and effective service provision. The data collected from these interviews were coded and analyzed using the principles of grounded theory. Findings The results of this study revealed that there was a general sense of unpreparedness when working with CLD clients. This lack of training also attributed to a deficiency of knowledge surrounding legislation governing service provision to CLD populations.

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