title: Skin allograft and vascularized composite allograft: potential for long-term efficacy in the context of lymphatic modulation.
abstract: Tissue transplantation restores form and function in burn patients. The treatment of burn injuries is influenced by severity, location, and the percentage of total body surface area. There have been a number of different techniques developed to temporize and repair the destroyed tissue. However, in patients with large wound burden, sufficient donor site tissue may not be available for autograft harvesting. Such extensive burns necessitate other temporary and permanent options for wound coverage such as skin or vascularized composite allografts (VCA). Rejection of these tissues presents an ongoing problem which is currently managed using a host of systemic immunosuppressive medications. This article discusses the mechanism behind the innate and adaptive immune systems rejection of the allografts. By understanding these pathways, various techniques using immunomodulatory protocols have led to increased allograft survival. However, our primary interest lies in the initial recognition of the graft. We tailor this article to have a specific emphasis on lymphatic modulation as a potential adjunctive therapy. Reviews of the studies evaluating the effect of lymph node modulation on graft survival are described with future implications to allograft transplant research.
authors: From the Departments of *Surgery, Section of Plastic Surgery, and †Biostatistics, University of Michigan, Ann Arbor.
authors: Jacob
authors: J
authors: Rinkinen
authors: Ryan
authors: R
authors: Selley
authors: Shailesh
authors: S
authors: Agarwal
authors: Shawn
authors: S
authors: Loder
authors: Benjamin
authors: B
authors: Levi
mesh_terms: D056704:Adaptive Immunity / Q000276:immunology; D064591:Allografts / Q000098:blood supply* / Q000276:immunology*; D017951:Antigen Presentation / Q000276:immunology; D002056:Burns / Q000276:immunology / Q000601:surgery*; D046528:Chimerism; D064595:Composite Tissue Allografts / Q000098:blood supply / Q000276:immunology; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000276:immunology*; D016038:Skin Transplantation / Q000379:methods*