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2008 Annual Meeting Abstracts

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Survey on current attitudes towards composite tissue allotransplantation in North America
Emilia A. Ploplys, MD, David W. Mathes, MD.
University of Washington, Seattle, WA, USA.

PURPOSE:
The clinical feasibility of composite tissue allotransplantation (CTA) has been substantiated by the successful transplantation of the hand, abdominal wall and partial face. While these transplants have the potential to reconstruct “like with like,” the risk-benefit ratio and clinical indications are difficult to determine. We sought to examine the current attitudes regarding the emerging field of CTA from those who treat complex facial injuries.
METHODS:
In 2007, a web based survey regarding CTA was sent to members of the American Burn Association, the Association of Academic Chairmen of Plastic Surgery, Canadian burn surgeons, Canadian plastic surgery program directors and plastic surgeons involved in facial reconstruction. The survey was blinded and examined the practice profile with regards to patients with complex facial injuries. The respondents assessed the level of risk for the different types of CTA and the indications for facial transplantation. Finally, three clinical situations were presented; two closely mirroring the recent facial transplantations performed in France and China and one hypothetical severe facial burn patient. The respondents were asked to evaluate their suitability for transplantation.
RESULTS:
157 surgeons responded to the survey (52.3% response rate). They averaged 18.5 years in practice and saw approximately 10.8 severe facial injury patients per year. The majority (78.3%) agreed that current techniques do not provide adequate reconstruction of severe facial injuries. The respondents also agreed (91%) with the guiding principals regarding facial transplantation issued by the ASRM/ASPS. However, opinion was divided on the acceptability of facial transplantation on current immunosuppression with 26% in favor. The majority of surgeons wished to wait for 10 year data on the current patients (16%), see improvement in immunosuppression (21.3%), or for the clinical application of tolerance protocols (27%).
Multiple failed reconstructions (70%), absence of remote tissue (56%), and total facial burn (59%) were determined to be the most acceptable indications. There was support (42%) for the use of transplantation in those patients that have lost their nose and lips. 9.7% felt that there is no acceptable indication for facial transplantation. The single group most opposed to transplantation was the non-plastic surgery trained burn surgeons where 15% felt that it was not justifiable. The scenarios that mimicked the recent clinical transplants garnered moderate support in favor of transplantation (21.3% for the Chinese patient scenario and 30.6% for the French patient scenario). The hypothetical severe burn patient scenario yielded the most support for a facial transplant with current immunosuppression (48.4%).
CONCLUSION:
This survey demonstrates support for the use of CTA to reconstruct complex facial deformities. However, surgeons continue to be wary of immunosuppression, chronic rejection and many want to wait for better immunologic treatment options.


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