title: Composite tissue allotransplantation of the hand and face: a new frontier in transplant and reconstructive surgery.
abstract: Each year an estimated 7-million people in the USA need composite tissue reconstruction because of surgical excision of tumors, accidents and congenital malformations. Limb amputees alone comprise over 1.2 million of these. This figure is more than double the number of solid organs needed for transplantation. Composite tissue allotransplantation in the form of hand and facial tissue transplantation are now a clinical reality. The discovery, in the late 1990s, that the same immunotherapy used routinely in kidney transplantation was also effective in preventing skin rejection made this possible. While these new treatments seem like major advancements most of the surgical, immunological and ethical methods used are not new at all and have been around and routinely used in clinical practice for some time. In this review of composite tissue allotransplantation, we: (i) outline the limitations of conventional reconstructive methods for treating severe facial disfigurement, (ii) review the history of composite tissue allotransplantation, (iii) discuss the chronological scientific advances that have made it possible, (iv) focus on the two unique clinical scenarios of hand and face transplantation, and (v) reflect on the critical issues that must be addressed as we move this new frontier toward becoming a treatment in mainstream medicine.
authors.affiliation: Department of Surgery, University of Louisville, KY 40202, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Gander
authors.forename: Charles S
authors.initials: CS
authors.lastname: Brown
authors.forename: Dalibor
authors.initials: D
authors.lastname: Vasilic
authors.forename: Allen
authors.initials: A
authors.lastname: Furr
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Banis
authors.forename: Michael
authors.initials: M
authors.lastname: Cunningham
authors.forename: Osborne
authors.initials: O
authors.lastname: Wiggins
authors.forename: Claudio
authors.initials: C
authors.lastname: Maldonado
authors.forename: Iain
authors.initials: I
authors.lastname: Whitaker
authors.forename: Gustavo
authors.initials: G
authors.lastname: Perez-Abadia
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Frank
authors.forename: John H
authors.initials: JH
authors.lastname: Barker
mesh_terms: D005145:Face / Q000601:surgery*; D005151:Facial Injuries / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006225:Hand / Q000601:surgery*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D008297:Male; D019651:Plastic Surgery Procedures; D016378:Tissue Transplantation / Q000379:methods*; D014181:Transplantation Immunology; D014184:Transplantation, Homologous / Q000379:methods*