Skin area quantification in preparation for concomitant upper extremity and face transplantation: A cadaver study and literature review

Chad R. Gordon; Fatih Zor; Maria Siemionow

doi:10.1097/TP.0b013e318212c815

Skin area quantification in preparation for concomitant upper extremity and face transplantation: A cadaver study and literature review

Chad R. Gordon, Fatih Zor, Maria Siemionow

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

Abstract

Background: Numerous experiments in composite tissue allotransplantation (CTA) have identified skin as the most antigenic, with recent experimentation from our laboratory finding a direct correlation between large antigenic skin loads and chimerism. Therefore, in preparation for clinical application of concomitant upper extremity (UExt) and face transplantation, we aimed to identify the exact skin quantities accompanying various upper UExt and concomitant scenarios using a cadaver study. METHODS.: Five fresh cadavers were obtained and dissections were performed to simulate five different UExt transplant levels. Exact skin quantities (cm) and total body surface area (TBSA) percentages were calculated using digital image analysis for both unilateral and bilateral hand transplant levels. UExt measurements were then cross-analyzed with our laboratory's facial/scalp alloflap data for similar evaluation of various concomitant CTA scenarios. RESULTS.: Skin quantities for unilateral hand transplants ranged from 335 (±58) to 787 (±82) cm, and from 670 (±117) to 1575 (±163) cm for bilateral. Concomitant CTA quantities (from "unilateral wrist-level with face" to "bilateral elbow-level with face/scalp") extended from 1010 (±81) to 2766 (±202) cm, totaling a range of 5.6% to 15.4% TBSA. CONCLUSION.: The findings presented here, for the first time, define exact skin quantities and TBSA percentages accompanying unilateral, bilateral, and concomitant hand/face transplant scenarios. Unilateral UExt transplants contain between 335 and 787 cm and bilateral between 670 and 1575 cm. Concomitant face/scalp and UExt transplants contain between 1000 and 2800 cm, equating 5% to 15% TBSA. Furthermore, there exists a tremendous void in research and some inconsistencies between animal investigation and clinical experience related to large skin-bearing CTAs. These concerns warrant further investigation by all teams pursuing concomitant CTA.

Original language	English (US)
Pages (from-to)	1050-1056
Number of pages	7
Journal	Transplantation
Volume	91
Issue number	9
DOIs	https://doi.org/10.1097/TP.0b013e318212c815
State	Published - May 15 2011
Externally published	Yes

Keywords

Antigenic skin quantity
Concomitant composite tissue allotransplant
Face transplant
Hand allograft
Langerhans cell
Upper extremity transplant

ASJC Scopus subject areas

Transplantation

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10.1097/TP.0b013e318212c815

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title = "Skin area quantification in preparation for concomitant upper extremity and face transplantation: A cadaver study and literature review",

abstract = "Background: Numerous experiments in composite tissue allotransplantation (CTA) have identified skin as the most antigenic, with recent experimentation from our laboratory finding a direct correlation between large antigenic skin loads and chimerism. Therefore, in preparation for clinical application of concomitant upper extremity (UExt) and face transplantation, we aimed to identify the exact skin quantities accompanying various upper UExt and concomitant scenarios using a cadaver study. METHODS.: Five fresh cadavers were obtained and dissections were performed to simulate five different UExt transplant levels. Exact skin quantities (cm) and total body surface area (TBSA) percentages were calculated using digital image analysis for both unilateral and bilateral hand transplant levels. UExt measurements were then cross-analyzed with our laboratory's facial/scalp alloflap data for similar evaluation of various concomitant CTA scenarios. RESULTS.: Skin quantities for unilateral hand transplants ranged from 335 (±58) to 787 (±82) cm, and from 670 (±117) to 1575 (±163) cm for bilateral. Concomitant CTA quantities (from {"}unilateral wrist-level with face{"} to {"}bilateral elbow-level with face/scalp{"}) extended from 1010 (±81) to 2766 (±202) cm, totaling a range of 5.6% to 15.4% TBSA. CONCLUSION.: The findings presented here, for the first time, define exact skin quantities and TBSA percentages accompanying unilateral, bilateral, and concomitant hand/face transplant scenarios. Unilateral UExt transplants contain between 335 and 787 cm and bilateral between 670 and 1575 cm. Concomitant face/scalp and UExt transplants contain between 1000 and 2800 cm, equating 5% to 15% TBSA. Furthermore, there exists a tremendous void in research and some inconsistencies between animal investigation and clinical experience related to large skin-bearing CTAs. These concerns warrant further investigation by all teams pursuing concomitant CTA.",

keywords = "Antigenic skin quantity, Concomitant composite tissue allotransplant, Face transplant, Hand allograft, Langerhans cell, Upper extremity transplant",

author = "Gordon, {Chad R.} and Fatih Zor and Maria Siemionow",

year = "2011",

month = may,

day = "15",

doi = "10.1097/TP.0b013e318212c815",

language = "English (US)",

volume = "91",

pages = "1050--1056",

journal = "Transplantation",

issn = "0041-1337",

publisher = "Lippincott Williams and Wilkins",

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TY - JOUR

T1 - Skin area quantification in preparation for concomitant upper extremity and face transplantation

T2 - A cadaver study and literature review

AU - Gordon, Chad R.

AU - Zor, Fatih

AU - Siemionow, Maria

PY - 2011/5/15

Y1 - 2011/5/15

N2 - Background: Numerous experiments in composite tissue allotransplantation (CTA) have identified skin as the most antigenic, with recent experimentation from our laboratory finding a direct correlation between large antigenic skin loads and chimerism. Therefore, in preparation for clinical application of concomitant upper extremity (UExt) and face transplantation, we aimed to identify the exact skin quantities accompanying various upper UExt and concomitant scenarios using a cadaver study. METHODS.: Five fresh cadavers were obtained and dissections were performed to simulate five different UExt transplant levels. Exact skin quantities (cm) and total body surface area (TBSA) percentages were calculated using digital image analysis for both unilateral and bilateral hand transplant levels. UExt measurements were then cross-analyzed with our laboratory's facial/scalp alloflap data for similar evaluation of various concomitant CTA scenarios. RESULTS.: Skin quantities for unilateral hand transplants ranged from 335 (±58) to 787 (±82) cm, and from 670 (±117) to 1575 (±163) cm for bilateral. Concomitant CTA quantities (from "unilateral wrist-level with face" to "bilateral elbow-level with face/scalp") extended from 1010 (±81) to 2766 (±202) cm, totaling a range of 5.6% to 15.4% TBSA. CONCLUSION.: The findings presented here, for the first time, define exact skin quantities and TBSA percentages accompanying unilateral, bilateral, and concomitant hand/face transplant scenarios. Unilateral UExt transplants contain between 335 and 787 cm and bilateral between 670 and 1575 cm. Concomitant face/scalp and UExt transplants contain between 1000 and 2800 cm, equating 5% to 15% TBSA. Furthermore, there exists a tremendous void in research and some inconsistencies between animal investigation and clinical experience related to large skin-bearing CTAs. These concerns warrant further investigation by all teams pursuing concomitant CTA.

AB - Background: Numerous experiments in composite tissue allotransplantation (CTA) have identified skin as the most antigenic, with recent experimentation from our laboratory finding a direct correlation between large antigenic skin loads and chimerism. Therefore, in preparation for clinical application of concomitant upper extremity (UExt) and face transplantation, we aimed to identify the exact skin quantities accompanying various upper UExt and concomitant scenarios using a cadaver study. METHODS.: Five fresh cadavers were obtained and dissections were performed to simulate five different UExt transplant levels. Exact skin quantities (cm) and total body surface area (TBSA) percentages were calculated using digital image analysis for both unilateral and bilateral hand transplant levels. UExt measurements were then cross-analyzed with our laboratory's facial/scalp alloflap data for similar evaluation of various concomitant CTA scenarios. RESULTS.: Skin quantities for unilateral hand transplants ranged from 335 (±58) to 787 (±82) cm, and from 670 (±117) to 1575 (±163) cm for bilateral. Concomitant CTA quantities (from "unilateral wrist-level with face" to "bilateral elbow-level with face/scalp") extended from 1010 (±81) to 2766 (±202) cm, totaling a range of 5.6% to 15.4% TBSA. CONCLUSION.: The findings presented here, for the first time, define exact skin quantities and TBSA percentages accompanying unilateral, bilateral, and concomitant hand/face transplant scenarios. Unilateral UExt transplants contain between 335 and 787 cm and bilateral between 670 and 1575 cm. Concomitant face/scalp and UExt transplants contain between 1000 and 2800 cm, equating 5% to 15% TBSA. Furthermore, there exists a tremendous void in research and some inconsistencies between animal investigation and clinical experience related to large skin-bearing CTAs. These concerns warrant further investigation by all teams pursuing concomitant CTA.

KW - Antigenic skin quantity

KW - Concomitant composite tissue allotransplant

KW - Face transplant

KW - Hand allograft

KW - Langerhans cell

KW - Upper extremity transplant

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JO - Transplantation

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Skin area quantification in preparation for concomitant upper extremity and face transplantation: A cadaver study and literature review

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Keywords

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