Marvee Turk

Transformation of Face Transplants: Volumetric and Morphologic Graft Changes Resemble Aging After Facial Allotransplantation.

Facial allotransplantation restores normal anatomy to severely disfigured faces. Although >30 such operations performed worldwide have yielded promising short‐term results, data on long‐term outcomes remain scarce. Three full‐face transplant recipients were followed for 40 months. Severe changes in volume and composition of the facial allografts were noted. Data from computed tomography performed 6, 18 and 36 months after transplantation were processed to separate allograft from recipient tissues and further into bone, fat and nonfat soft tissues. Skin and muscle biopsies underwent diagnostic evaluation. All three facial allografts sustained significant volume loss (mean 19.55%) between 6 and 36 months after transplant. Bone and nonfat soft tissue volumes decreased significantly over time (17.22% between months 6 and 18 and 25.56% between months 6 and 36, respectively), whereas fat did not. Histological evaluations showed atrophy of muscle fibers. Volumetric and morphometric changes in facial allografts have not been reported previously. The transformation of facial allografts in this study resembled aging through volume loss but differed substantially from regular aging. These findings have implications for risk–benefit assessment, donor selection and measures counteracting muscle and bone atrophy. Superior long‐term outcomes of facial allotransplantation will be crucial to advance toward future clinical routine.

Trendy Tattoos—Maybe a Serious Health Risk?

BackgroundThe literature reports many cases of cutaneous malignancy in the setting of skin tattoos. In this study, we review the reported incidence of and risk factors for tattoo-associated skin cancer.MethodsA PubMed literature review was performed for all cases of tattoo-associated skin cancer, including squamous cell carcinoma, basal cell carcinoma, malignant melanoma, keratoacanthoma, and other rare skin malignancies (source: PubMed/until June 2017).ResultsThe authors identified 51 publications and 63 total cases of tattoo-associated skin cancer. We also report on a single new case of tattoo-associated skin cancer observed at one of our co-authors’ institutions. Among these 64 total cases, 58% were associated with black and blue inks and 34% were associated with red ink.ConclusionsOverall, while the strength of association remains unclear, the literature reports many cases of tattoo-associated skin cancer. Among these cases, black, blue, and red inks were particularly worrisome for their carcinogenic potential.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Psychological Outcomes in Face Transplant Recipients: A Literature Review

Purpose of ReviewTo synthesize findings regarding the psychological outcomes of face transplantation.Recent FindingsThirty-seven face transplants have been done since the world’s debutant case was featured in 2005. In spite of impressive clinical success, little has been achieved to date in terms of understanding the mental health, quality of life, and psychosocial outcomes of face transplant recipients.SummaryWe conducted a literature search in PubMed for studies reporting any psychosocial measure in face transplant recipients, between 2005 and 2017. We identified 20 articles: 11 articles reported qualitative evaluation of outcomes, and nine articles used quantitative measures. Recipients were generally satisfied with the aesthetic result of the procedure, succeeded in integrating the new face into their sense of self within the first few weeks to months post-transplant, and experienced a major and lasting improvement in social integration for years after the transplant. We recommend a systematic reporting of detailed psychosocial evaluations through the use of validated measures administered at regular intervals, to allow for the emergence of a population-level assessment of the psychosocial outcomes of face transplantation.

Perceived social support among patients with burn injuries: A perspective from the developing world

BACKGROUNDnSocial support is among the most well-established predictors of post-burn psychopathology after burn. Despite a disproportionately large burden of burns in the developing world, the nature of social support among burn patients in this context remains elusive. We, therefore, seek to investigate social support and its biopsychosocial determinants among patients with burn injuries in Pakistan.nnnMETHODSnA cross-sectional study of 343 patients presenting with burn injuries at four teaching hospitals in the Punjab province of Pakistan was conducted. Patient evaluation consisted of a multi-part survey of demographic status, clinical features, and social support as measured by the validated Urdu translation of the Multidimensional Scale of Perceived Social Support (MSPSS). Multiple regression analysis was performed to evaluate associations between patient characteristics and MSPSS score.nnnRESULTSnMean overall MSPSS score was 57.64 (std dev 13.57). Notable positive predictors of social support include male gender, Punjabi ethnicity, burn surface area, and ego resiliency.nnnCONCLUSIONnOur study reveals a troubling pattern of inadequate social support among certain subgroups of Pakistani burn patients. Addressing these inequities in the provision of social support must be prioritized as part of the global burn care agenda.

Quality of Life and Psychosocial Functioning Two Years Following Facial Transplantation

BACKGROUNDnFace transplantation is a novel option for patients with severe facial disfigurement. Quality of life (QoL) outcomes of face transplantation remain poorly understood.nnnOBJECTIVESnWe sought to evaluate psychosocial functioning among 6 patients undergoing facial transplantation.nnnMETHODSnWe prospectively assessed depressive symptoms, health status, mental and physical QoL, and self-esteem at 3-month intervals for 2 years. Social desirability was assessed pretransplant.nnnRESULTSnOn average, before transplantation, patients generally reported minimal to subthreshold depressive symptoms, normal to high health status, normal mental-health QoL, slightly below normal physical-health QoL, and normal to high self-esteem. Most endorsed high social desirability. As patients recovered from surgery, hospitalization, and immunosuppression induction, physical-health QoL generally deteriorated 3 months posttransplantation. Posttransplant trajectories show that perceived health state improved; health status and mental and physical health-related QoL slightly improved; self-esteem remained stable and high; and overall depressive symptoms remained stable but 3 patients experienced a depressive episode.nnnCONCLUSIONSnPretransplant ceiling effects may render improvements difficult to quantify. Future research should use mixed methods including population-specific measures with demonstrated sensitivity to change.

Reduced hypoxia-related genes in porcine limbs in ex vivo hypothermic perfusion versus cold storage

BACKGROUNDnIschemia-reperfusion injury remains the major limiting factor for limb replantation and transplantation. Static cold storage (SCS) on ice currently represents the standard mode of preservation but is limited to 6 h of duration. Exxa0vivo machine perfusion has evolved as a potential alternative to safely extend the duration of exxa0vivo preservation by providing continuous supply of oxygen and nutrients. This study aims to evaluate underlying molecular mechanisms of both preservation modalities.nnnMETHODSnWe assessed molecular changes in amputated porcine forelimbs stored on ice at 4°C for 2 h (nxa0=xa02) and limbs perfused with Perfadex solution at 10°C for 2 h (nxa0=xa03) or 12 h (nxa0=xa03) before replantation. Muscle biopsies were examined for histological changes and gene expression levels using H&E staining and a hypoxia-related PCR gene array, respectively.nnnRESULTSnHistology revealed only minor differences between the ice (SCS) and perfusion groups after 2 h of preservation, with decreased muscle fiber disruption in the perfusion groups compared with the ice (SCS) group. Perfused limbs demonstrated downregulation of genes coding for glycolytic pathways and glucose transporters after 2 h and 12 h when compared with SCS after 2 h. Similarly, genes that induce angiogenesis and those that are activated on DNA damage were downregulated in both perfusion groups as compared with SCS.nnnCONCLUSIONSnPerfusion of porcine limbs resulted in less activation of hypoxia-related gene families when compared with SCS. This may indicate a state more closely resembling physiological conditions during perfusion and potentially limiting ischemic injury. Our study confirms exxa0vivo perfusion for up to 12 h as a viable alternative for preservation of vascularized composite tissues.

Tissue conservation for transplantation

Abstract Pathophysiological changes that occur during ischemia and subsequent reperfusion cause damage to tissues procured for transplantation and also affect long-term allograft function and survival. The proper preservation of organs before transplantation is a must to limit these injuries as much as possible. For decades, static cold storage has been the gold standard for organ preservation, with mechanical perfusion developing as a promising alternative only recently. The current literature points to the need of developing dedicated preservation protocols for every organ, which in combination with other interventions such as ischemic preconditioning and therapeutic additives offer the possibility of improving organ preservation and extending it to multiple times its current duration. This review strives to present an overview of the current body of knowledge with regard to the preservation of organs and tissues destined for transplantation.

Predictors of post-traumatic stress disorder among burn patients in Pakistan: The role of reconstructive surgery in post-burn psychosocial adjustment

BACKGROUNDnBurns are a common cause of morbidity and mortality worldwide. Post-traumatic stress disorder (PTSD) is among the most prevalent psychopathologies documented among burn patients. However, little is known regarding the risk factors for post-burn PTSD outside the well-documented Western world context. The present study aims to elucidate the biopsychosocial correlates of PTSD among burn patients in Pakistan.nnnMETHODSnA total 343 burn patients were evaluated across four teaching hospitals in the Punjab province of Pakistan between August and December of 2016. Patients aged 18 years or older, with no major comorbid illnesses, presenting for burn care at burn units or surgical departments of the listed hospitals were interviewed by trained healthcare providers using a validated questionnaire. Uni- and multivariate statistical analyses were used to evaluate associations between patient characteristics and PTSD symptomatology, as measured by the validated Urdu version of the Impact of Event Scale-Revised (IES-R).nnnRESULTSnThe prevalence of PTSD among our cohort was 69%. Lower educational attainment, ethnic minority status, unemployment, large burn surface area, prior suicidal ideation, and domestic violence were all associated with increased PTSD symptomatology. On the other hand, social support, ego resiliency, and reconstructive surgery were all associated with decreased PTSD symptomatology.nnnCONCLUSIONnThere is a remarkably high prevalence of PTSD among burn patients in Pakistan. Improving accessibility to reconstructive surgery and social support may help to alleviate this burden.