scholarly journals Autologous Reconstruction of a Face Transplant Candidate

2019 ◽  
Vol 12 (2) ◽  
pp. 150-155
Author(s):  
William J. Rifkin ◽  
Justin L. Bellamy ◽  
Rami S. Kantar ◽  
Scott J. Farber ◽  
J.Rodrigo Diaz-Siso ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Autologous Reconstruction ◽  
Exclusion Criteria ◽  
Representative Case ◽  
Facial Disfigurement ◽  
Facial Transplantation ◽  
Face Transplant ◽  
Reconstructive Option ◽  
Transplant Candidate ◽  
Reconstructive Techniques

Since 2005, facial transplantation has emerged as a viable reconstructive option for the most severe defects not amenable to conventional reconstructive techniques, with promising aesthetic and functional outcomes to date. Key facial subunits and midface structures such as the eyelids, lips, and nose are now able to be successfully replaced rather than reconstructed, enabling adequate functional outcomes in even the most extensive defects. However, even in cases of severe facial disfigurement, the decision to proceed with transplantation versus autologous reconstruction remains a source of debate, with no current consensus regarding precise indications and inclusion/exclusion criteria. This report details the case of a candidate referred for face transplantation who ultimately underwent autologous facial reconstruction. Through this representative case, our objective is to clarify the criteria that make a patient a suitable face transplant candidate, as well as to demonstrate the outcomes achievable with a conventional autologous reconstruction, using a methodically planned, multistaged approach.

Transplant Professionals' Attitudes toward Facial Transplantation in the United Kingdom

2007 ◽  
Vol 17 (3) ◽  
pp. 228-233 ◽  
Author(s):  
Alex Clarke ◽  
Fidelma Murphy ◽  
Paul White ◽  
Veronica Brough ◽  
Anthony Renshaw ◽  
...  
Keyword(s):  
Attitudes And Beliefs ◽  
Facial Transplantation ◽  
The United Kingdom ◽  
Retrieval Team ◽  
Reconstructive Option ◽  
Areas Of Concern ◽  
High Level ◽  
The Impact ◽  
Reconstructive Techniques ◽  
Relevant Education

Background In November 2005, the world's first partial facial transplantation positioned this treatment at the forefront in the development of facial reconstructive techniques. Objective Because the procedure is dependent on donation of facial tissue, we sought to understand the attitudes and beliefs of the general public and transplant professionals toward this treatment. Methods This research reports the results of a survey of 170 transplant professionals sampled by means of a questionnaire generated by a focus group of transplant coordinators. Results We found a high level of support for facial transplantation, with 76% of respondents in favor and none opposed to the procedure in principle. There was a significant association between knowing someone with a disfiguring condition and being in favor of facial transplantation. Areas of concern to this group can be summarized as factors that affect organ retrieval and the impact on the retrieval team and the donor family. Conclusions Consistency in ranking of item importance provides the basis for development of relevant education materials, team liaison, and care pathways. These findings also validate the use of focus groups in sampling issues of concern to relevant groups as facial transplantation takes its place as a reconstructive option.

Facial Transplantation

2018 ◽  
Author(s):  
Mario A Aycart ◽  
Bohdan Pomahac
Keyword(s):  
Functional Outcomes ◽  
Medical Community ◽  
Short Term ◽  
Comprehensive Overview ◽  
Composite Tissue ◽  
The Past ◽  
Facial Transplantation ◽  
Composite Tissue Transplantation ◽  
Reconstructive Techniques

Although significant advances in craniofacial and microsurgical reconstructive techniques have allowed for the reliable reconstruction of complex head and neck defects, there are limitations to conventional therapy. In the past decade, the medical community has witnessed the growth and evolution of facial transplantation in becoming a clinical reality for the most severely disfigured individuals. Despite recent advances and promising short-term results, the risk-benefit trade-off is still evolving as more experience is gained. This chapter provides a comprehensive overview of indications, recipient evaluation, and immunosuppression. The latest outcomes’ data including functional outcomes, costs, quality of life, complications, and deaths from the emerging field of facial transplantation are also reviewed. This review contains 11 figures, 5 tables and 92 references Key Words: Facial Transplantation, Vascularized composite allotransplantation, Composite tissue transplantation, Reconstruction Microsurgery, Craniofacial Surgery, Transplant Surgery, Immunosuppression, Functional Outcomes

Toe-to-Finger Vascularized Joint Transfers for Proximal Interphalangeal Joint Reconstruction: A Systematic Review

Hand ◽  
2021 ◽  
pp. 155894472098808
Author(s):  
Kiane J. Zhou ◽  
David J. Graham ◽  
Richard D. Lawson ◽  
Brahman S. Sivakumar
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Autologous Reconstruction ◽  
Active Range Of Motion ◽  
Reconstructive Option ◽  
Meta Analyses ◽  
Extensor Lag

Vascularized joint transfer (VJT) from the proximal interphalangeal joint (PIPJ) of the toe is an attractive reconstructive option in cases of nonsalvageable finger PIPJ but is limited by equivocal functional outcomes. This systematic review aims to provide an update on vascularized toe-to-finger PIPJ transfers, examining functional outcomes, complications, and the latest refinements in operative technique. A systematic review of the available literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining vascularized toe-to-finger PIPJ transfer for post-traumatic indications were included for analysis. Outcomes assessed included postoperative active range of motion, extension lag, and complications. Thirteen studies examining 210 VJTs were analyzed. Five VJTs experienced microsurgical failure giving an overall survival rate of 97.6%. Average postoperative PIPJ active range of motion (ROM) was 40.3° ± 12.9°, with an average extensor lag of 29° ± 10.5° and mean flexion of 68.9° ± 10.9°. For studies reporting complication outcomes, 59/162 complications were seen. No significant differences were seen between studies published prior to 2013 and after 2013 when comparing digital ROM ( P = .123), flexion ( P = .602), and extensor lag ( P = .280). Studies using a reconstructive algorithm based on prior assessment of the donor toe central slip and recipient finger anatomy had significantly improved ROM outcomes ( P = .013). Although VJT provides a reliable option for autologous reconstruction in posttraumatic joints, it is limited by impaired postoperative ROM. Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes.

Utility Scores for Facial Disfigurement Requiring Facial Transplantation [Outcomes Article]

2010 ◽  
Vol 126 (2) ◽  
pp. 443-449 ◽  
Author(s):  
Hani H. Sinno ◽  
Stephanie Thibaudeau ◽  
Anil Duggal ◽  
Lucie Lessard
Keyword(s):  
Facial Disfigurement ◽  
Facial Transplantation ◽  
Transplantation Outcomes ◽  
Utility Scores

Facial transplantation: historical developments and future directions

2015 ◽  
Vol 129 (3) ◽  
pp. 206-211 ◽  
Author(s):  
G L Garrett ◽  
I Beegun ◽  
A D'souza
Keyword(s):  
Functional Outcomes ◽  
Ethical Issues ◽  
Infectious Complications ◽  
Future Directions ◽  
Facial Transplantation ◽  
The Social ◽  
Bibliographic Search ◽  
Historical Developments

AbstractObjective:To present the clinical outcomes obtained by the first facial transplant teams worldwide, reviewing current practice and addressing controversies.Methods:A bibliographic search of Medline and Embase databases was performed, and a comparative analysis of all articles published from 1980 to the present was conducted. Two independent investigators screened the manuscripts in accordance with pre-defined criteria.Results:A total of 12 partial and 5 full facial transplants were recorded in the literature. Procedures included partial and near-total facial myocutaneous flaps, and complex osteomyocutaneous grafts. Fifteen patients had fully vascularised grafts, and two patients died of transplant-related and infectious complications.Conclusion:Facial transplantation can restore quality of life and enable the social re-integration of recipients. Results published by the first facial transplant teams are promising. However, long-term reports of aesthetic and functional outcomes are needed to more precisely define outcomes. In addition, significant technical, medical and ethical issues remain to be solved.

scholarly journals Difficulties in resuscitating adult skeletal injury and trauma: a systemic review

2017 ◽  
Vol 4 (10) ◽  
pp. 3206
Author(s):  
Turki Abdullah S. Al-ajmi ◽  
Abdullah Salah Al-hussain ◽  
Mohammed Fuad Al-Abdulqader
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Data Extraction ◽  
Systemic Review ◽  
Trauma Resuscitation ◽  
Exclusion Criteria ◽  
Factors Affecting ◽  
Skeletal Injury ◽  
Second Stage ◽  
Critical Aspects

Background: Trauma resuscitations are complicated, high-risk, and time-sensitive actions that need the coordination of different specialists arriving from multiple areas in the hospital. This systematic review aimed to understand the main key challenges of trauma resuscitations using a broad search in various database.Methods: A systematic review of published articles between the years 2000 and 2016 was conducted using different electronic databases such as PubMed, Medline and Embase to identify studies evaluating trauma resuscitations challenges. Different keywords were used in this study to recognize relevant articles. The titles of all articles were scanned in the first stage. Irrelevant articles were omitted and the abstracts of the rest articles were reviewed in the second stage. Finally, the full text of all articles which met the inclusion and exclusion criteria were reviewed and a data extraction sheet was made to summarize all the articles. Data were analyzed descriptively.Results: Twenty studies were reviewed including; RCT (3 studies), QRCT (5 studies), and descriptive study (12 studies). The results showed that there are four main trauma resuscitation challenges including pre-hospital challenges, error-related challenges, equipment and technical challenges, and finally general challenges.Conclusions: Trauma resuscitation is one of the most critical aspects of emergency care. It is necessary to promote resuscitation care and focus on patient outcomes in terms of mortality and more importantly, functional outcomes. Considering these main factors affecting trauma resuscitation will improve patients’ outcomes and help those who are engaged in providing services.

Tracheoesophageal Voice Restoration After Salvage Total Laryngectomy

2009 ◽  
Vol 19 (2) ◽  
pp. 58-65 ◽  
Author(s):  
Donna J. Graville ◽  
Andrew D. Palmer ◽  
Mark K. Wax ◽  
Peter E. Andersen
Keyword(s):  
Functional Outcomes ◽  
Total Laryngectomy ◽  
Previous Treatment ◽  
Primary Treatment ◽  
Positive Outcomes ◽  
Recurrent Cancer ◽  
Voice Restoration ◽  
Tracheoesophageal Puncture ◽  
Dramatic Shift ◽  
Reconstructive Techniques

Abstract Since the 1990s there has been a dramatic shift in the management of advanced laryngeal cancer. Today chemoradiation is often performed as a primary treatment with “salvage” total laryngectomy being performed subsequently if needed. In this article, the authors review the current protocols for the diagnosis of recurrent cancer, the surgical and reconstructive techniques used, and the strategies for management of post-operative complications. There is a paucity of literature about the functional outcomes after this type of procedure. It is known that voice restoration with a tracheoesophageal puncture may be challenging in this population of patients due to the complications associated with their previous treatment. Nonetheless, with appropriate patient selection, careful problem-solving, and persistence, positive outcomes may be achieved.

scholarly journals Evidence-Based Practice in Rehabilitation of Myasthenia Gravis. A Systematic Review of the Literature

2020 ◽  
Vol 5 (4) ◽  
pp. 71
Author(s):  
Bruno Corrado ◽  
Benedetto Giardulli ◽  
Massimo Costa
Keyword(s):  
Myasthenia Gravis ◽  
Functional Outcomes ◽  
Balance Training ◽  
Neuromuscular Disorder ◽  
Final Phase ◽  
Exclusion Criteria ◽  
Scientific Databases ◽  
Respiratory Training ◽  
Meta Analyses

Myasthenia gravis is a rare neuromuscular disorder characterized by muscle weakness and fatigue. This review analyzes the most recent evidence regarding the effectiveness and safety of different rehabilitative approaches to the disease. The review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 365 articles were found in the main scientific databases. Applying the inclusion/exclusion criteria, 11 studies were admitted to the final phase of the review. Three different rehabilitative approaches were identified: physical training, respiratory training, and balance training. All rehabilitative modalities contributed to enhancing functional outcomes, reducing fatigue, and improving quality of life, but currently none can be recommended over another for the lack of cross-comparative studies. The included studies showed methodological quality from low to fair. Despite the range of rehabilitative interventions available, there is a lack of high-quality evidence. However, this review suggests that a multidisciplinary rehabilitation approach should be recommended to people with myasthenia gravis, and above all, for those with mild to moderate symptomatology.

scholarly journals P.059 A systematically conducted review of the Full Outline of UnResponsiveness (FOUR) score and its use in outcome prediction

2018 ◽  
Vol 45 (s2) ◽  
pp. S31-S31
Author(s):  
A Almojuela ◽  
FA Zeiler ◽  
M Hasen ◽  
CM Honey
Keyword(s):  
Functional Outcomes ◽  
Outcome Prediction ◽  
Pediatric Population ◽  
Outcome Predictor ◽  
Exclusion Criteria ◽  
Observer Reliability ◽  
Prediction Of Mortality ◽  
Level Of Consciousness ◽  
Pediatric Populations ◽  
Four Score

Background: Our goal was to perform a scoping systematic review of the literature on the application of the FOUR score within critically ill patients. Methods: 6 databases were searched. Two reviewers independently screened the results. Inclusion and exclusion criteria were applied to each article to obtain final articles for review. Results: The initial search yielded 1709 citations. Of those used, 49 were based on adult and 6 on pediatric populations. All but 8 retrospective adult studies were performed prospectively. Patient categories included traumatic brain injury, intraventricular hemorrhage, intracerebral hemorrhage, subarachnoid hemorrhage, ischemic stroke, general/combined neurology and neurosurgery, post-cardiac arrest, medicine/general critical illness, and patients in the emergency department. A total of 9092 adult patients were studied. 14 studies demonstrated good inter-observer reliability of the FOUR score. 9 studies demonstrated prognostic value of the FOUR score in predicting mortality and functional outcomes. 31 studies demonstrated equivalency or superiority of the FOUR score compared to GCS in prediction of mortality and functional outcomes. Similar results were seen for the pediatric population. Conclusions: The FOUR score has been shown to be a useful outcome predictor in many patients with depressed level of consciousness. It displays good inter-rater reliability among physicians and nurses.

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