Citations 2
Vascularized Composite Allograft Versus Prosthetic for Reconstruction After Facial and Hand Trauma
Noel, Olivier F. , Daoud, Deborah , Colen, David L. , Dumbrava, Mihai G, Dumbravă, Mihai , Kammien, Alexander J. , Kauke‐Navarro, Martin , Pomahač, Bohdan
Annals of Plastic Surgery | November 14, 2023 | Volume: 92 | Issue: 1 | Pages: 100-105
Abstract In the past decade, vascularized composite allotransplantation (VCA) has become clinical reality for reconstruction after face and hand trauma. It offers patients the unique opportunity to regain form and function in a way that had only been achieved with traditional reconstruction or with the use of prostheses. On the other hand, prostheses for facial and hand reconstruction have continued to evolve over the years and, in many cases, represent the primary option for patients after hand and face trauma. We compared the cost, associated complications, and long-term outcomes of VCA with prostheses for reconstruction of the face and hand/upper extremity. Ultimately, VCA and prostheses represent 2 different reconstructive options with distinct benefit profiles and associated limitations and should ideally not be perceived as competing choices. Our work adds a valuable component to the general framework guiding the decision to offer VCA or prostheses for reconstruction after face and upper extremity trauma.
Cytomegalovirus-related Complications and Management in Facial Vascularized Composite Allotransplantation: An International Multicenter Retrospective Cohort Study
Kauke-Navarro, Martin, Panayi, Adriana C., Formica, Richard, Marty, Francisco, Parikh, Neil, Foroutanjazi, Sina, Safi, Ali-Farid, Mardini, Samir, Razonable, Raymund R., Morelon, Emmanuel, Gelb, Bruce, Rodriguez, Eduardo, Lassus, Patrik, Pomahac, Bohdan, Kauke‐Navarro, Martin , Panayi, Adriana Christine , Formica, Richard, Marty, Francisco, Parikh, Neil, Foroutanjazi, Sina, Safi, Ali-Farid, Mardini, Samir, Razonable, Raymund R., Morelon, Emmanuel, Gelb, Bruce, Rodriguez, Eduardo, Lassus, Patrik, Pomahac, Bohdan
Transplantation | April 7, 2022 | Volume: 106 | Issue: 10 | Pages: 2031-2043
Background. There is a paucity of data on the impact of cytomegalovirus (CMV) serostatus and CMV infection on outcomes in facial vascularized composite allotransplantation. Methods. This international, multicenter, retrospective cohort study presents data on CMV and basic transplant-related demographics, including pretransplant viral D/R serostatus, and duration of antiviral prophylaxis. CMV-related complications (viremia, disease), allograft-related complications (rejection episodes, loss), and mortality were analyzed. Results. We included 19 patients, 4 of whom received CMV high-risk transplants (D+/R−). CMV viremia was noted in 6 patients (all 4 D+/R− patients and 2 D−/R+), mostly within the first-year posttransplant, shortly after discontinuation of antiviral prophylaxis (median 2 mo). CMV disease occurred in 2 D+/R− patients. The high-risk group experienced relatively more rejection episodes per month follow-up. None of D+/R− patients suffered allograft loss due to rejection (longest follow-up: 121 mo). Conclusions. D+/R− patients were at increased risk of CMV-related complications. Although a higher number of rejections was noted in this group, none of the D+/R− patients lost their allograft or died because of CMV or rejection. Thus, CMV D+/R− face transplantation can likely be safely performed with prophylaxis, active surveillance, and prompt treatment.