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Using a novel cadaver study to quantify potential antigenic skin loads accompanying concomitant face and upper extremity transplantation
Chad R. Gordon, DO
Maria Siemionow, MD, PhD
Bijan Eghtesad, MD
John Fung, MD
Frank Papay, MD
John
Cleveland Clinic
2010-03-18
Presenter: Chad R. Gordon, DO
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Background: Numerous composite tissue allotransplant (CTA) experiments studying relative component antigenicity have identified skin as the most severe. Therefore, in light of the unexpected death of the world's first concomitant face/bilateral upper extremity (UExt) transplant recipient and because very little pre-clinical research exists on the safety of concomitant CTA, we aimed to scientifically quantify the accompanying skin component.
Methods: Five cadavers were used and all dissections were performed to simulate UExt allotransplantation at various levels. Skin quantity was calculated for all dissections (n=25) and comparative analysis was performed based on our laboratory's previously-published facial alloflap data (n=5).
Results: The skin component accompanying unilateral UExt transplants ranged from 335(±58) to 787(±82) cm2, and from 670(±117) to 1575(±163) cm2 for bilateral. Facial/scalp alloflaps of 675(±22) cm2 were found nearly identical in quantity to both a unilateral proximal forearm transplant and bilateral wrist-level transplants (675±102 and 670±117 cm2, respectively). Concomitant face with unilateral wrist-level transplantation was the smallest dimension measuring 1010(±81) cm2. Facial/scalp with bilateral elbow-level UExt transplants was the largest, most impressive variant measuring 2766(±201.6) cm2.
Conclusion: This cadaver study has identified, for the first time, a wide spectrum of skin quantity accompanying concomitant CTA (range = 1010-2766 cm2). This equates to transplanting nearly 15% of one's total body surface area. Future research is necessary to 1) address pertinent immunological challenges associated with this complex operation, 2) investigate potential immunotherapy adjustments for large skin-volume CTA, and 3) to study whether or not skin from the face and upper extremity possess the same antigenicity.
