The Basic Study And Clinical Application Of Facial Allotransplantation

It is very difficult to repair traumatic deformities of face with defect of body surface organs such as ear, nose, eye and mouth, which are caused by burn injuries, gunshot wounds, or ablative tumor surgical procedures. Current reconstructive options, including skin grafts, local flaps, free-tissue transfers, and prefabricated flaps, still do not have satisfactory results. With the advancement of organ allotransplantation, many doctors introduce an ideal process of facial composite-tissue allograft transplantation.However, there are still many matters need to be overcome in composite face flap allotransplantation, including immunosuppression, the procedure of operation, social ethics and so on. In order to solve these matters, we understood a serial of study and did well. Following that, a human face allograft successfully operated in last year and had a good result. 1. A facial transplantation model in haresObjective To design a animal model to study the A facial transplantation of allografts in rabbits. Methods Livid blue rabbits and New Zealand white rabbits was applied as experiment animal,to harvest hemifacial composite-tissue flap based in the common carotid artery with the branch of the external mandibular artery and auricularis magna artery,then allotransplantation was performed with the livid blue rabbits as recipient while new Zealand rabbits as donor, the immunosuppressive agent comprised ciclosporin, azamun and prednisone . 25 couples of rabbits was divided three groups, group A,5 couples of rabbits, no administered immunosuppressive agent and the artery anastomosis with end-to-end. Group B, 10 couples of rabbits, administered immunosuppressive agent and the artery anastomosis with end-to-end. Group C,10 couples of rabbits , administered immunosuppressive agent and the artery anastomosis with end-to-side.Postoperative,to observe the survive ratio of animal and composite-tissue flap, verified the practicability of model further. Results the blood supply of hemifacial composite-tissue flap is rich after allotransplantation. The survive ratio wasn't different with different procedure of the external carotid artery anastomosis. Conclusion This is a successful model of composite face flap transplantation in the rabbits2. The study of triple therapy regiment strategy of immune suppression to composite face flap transplantationObjective In order to to institute a prophylaxis against rejection after facial allotransplantation, to study the triple therapy regiment strategy of immune suppression. Methods hemifacial composite-tissue flap were performed between Livid blue rabbits and New Zealand white rabbits, The immunosuppressive agent comprised FK506, MMF and prednisone. 45 couples of rabbits were divided into five groups. Group A consists of 5 couples of rabbits, with no immunosuppressive agent being administered. Group B,C,D,E has 10 couples of rabbits respectively, with administered immunosuppressive agent. GroupB were administered FK506 and MMF; Group C were administered FK506 and pred, and Group D administered MMF and pred. However, Group E were administered the triple therapy regiment (FK506 and MMF and pred). After operation, survival ratios of animal and composite-tissue flap have been observed., Rejection was assessed by visual inspection of flap skin and serial histopathologic examination of skin biopsy specimens, and the level of immunosuppression was assessed by detection of IL-2. Results Day 30 and 100 after allotransplantation, the ratio of rejection and the grade of histopathological study of skin biopsy specimens and the expression level of IL-2 were significantly lower in Group E than the others respectively without serious side effects. Conclusion This is a valuable triple therapy regiment strategy of immune suppression to composite face flap transplantation in the rabbits.3. The effect of topical rapamycin on the survival of rat lower abdominal flap allograftsObjective To study the effect of topical rapamycin on the survival of composite tissue allografts by the rat model of lower abdominal flap. Methods Lewis rat and Brown Norway rat was applied as experiment animal,to harvest the lower abdominal flap of Brown Norway rat based in the femoral artery and vein,then allotransplantation was performed to Lewis rat who was applied as recipient. 40 couples of rat was divided four groups, group A, systemic low-dose rapamycin; Group B, topical rapamycin; Group C, systemic low-dose rapamycin with topical rapamycin; Group D, blank control group with topical Azone. Postoperative,to observe the survive ratio of animal and composite-tissue flap, and the level of IL-2 so that verified the practicability of topical rapamycin. Results the survival time was 14.5d in Group A, 11.4d in Group B,22.5d in Group C,and 6.1d in Group D respectively. Topical therapy with rapamycin can survive the flap in a temporal time, however, systemic low-dose rapamycin with topical rapamycin can survive the flap in a long time. Conclusion topial rapamycin on the survival of composite tissue allografts was effective, but the effect was temporal. however, systemic low-dose rapamycin with topical rapamycin can survive the flap in a long time, so, topical therapy is a effective method to cut down the systemic dose of immunosuppressive agent with rapamycin.4. A human face allograftObjective Extended soft tissue defects of the face are difficult to reconstruct, and autologous tissue transfers usually lead to poor cosmetic and functional outcomes. We judged that composite tissue transplantation could be valuable in facial reconstructive surgery. Methods We transplanted a part face of a brain-dead man onto a man aged 30 years who had suffered amputation of nose, both lips, chin, and right cheeks, including inferior eyelid, part maxillary bone and jugal bone. Transplantation consisted of revascularisation of right facial arteries and veins (ischaemic time 4 h), mucosal repair of oral and nasal vestibules, bilateral anastomoses of infraorbital and mental sensitive nerves, joining of mimic muscles with motor nerve suture on mandibular branch of the left facial nerve, and skin closure. Immunosuppressive treatment was with tacrolimus, mycophenolate mofetil, prednisone and Zenopax. Follow-up included routine tests, biopsies, physiotherapy, and psychological support. Results The initial postoperative course was uneventful. No surgical complication occurred. Immunosuppression were well tolerated. Mild clinical signs of rejection were seen at month 4 and 5. Increased corticoids initially did not reverse rejection, but signs of rejection disappeared after three boluses of prednisone and FK506. Anatomical and psychological integration and recovery of sensation were excellent. Conclusion The 1-year outcome demonstrates the feasibility of this procedure. The functional result will be assessed in the future, but this graft can already be deemed successful with respect to appearance, sensitivity, and acceptance by the patient.