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Handchir Mikrochir Plast Chir 2014; 46(04): 206-213
DOI: 10.1055/s-0034-1385850
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Fortschritte in der Gesichtstransplantation

Progress in Face Transplantation
M. Kueckelhaus
1   Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, United States
2   Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumore, BG Universitätsklinik Bergmannsheil, Bochum
,
M. Lehnhardt
2   Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumore, BG Universitätsklinik Bergmannsheil, Bochum
,
S. Fischer
1   Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, United States
,
E. Eriksson
1   Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, United States
,
B. Pomahac
1   Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, United States
,
T. Hirsch
2   Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumore, BG Universitätsklinik Bergmannsheil, Bochum
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Publikationsverlauf

eingereicht 20. März 2014

akzeptiert 09. Juli 2014

Publikationsdatum:
27. August 2014 (online)

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Zusammenfassung

Die Vascularised Composite Allostranspantation (VCA) dient zur Restoration komplexer Defekte. Restoration beschreibt in diesem Zusammenhang die Wiederherstellung von destruiertem Gewebe durch anatomisch identische Strukturen. Bis heute sind weltweit insgesamt bereits über 150 VCAs, davon 31 Gesichtstransplanta­tionen, durchgeführt worden. Die Gesichtstransplantation stellt keine primär lebenserhaltende Maßnahme dar, sondern dient der Verbesserung der Lebensqualität betroffener Patienten. Aufgrund der sich zwingend anschließenden lebenslangen Immunsuppression und den damit verbunden potentiell lebensbedrohlichen Nebenwirkungen ist eine äußerst strenge Indikationsstellung mit individueller Bewertung des Kosten-Nutzen-Verhältnisses essentiell. Sichere Revaskularisation und möglichst vollständige ästhetische und funktionelle Reintegration sind die ultimativen Ziele der Gesichtstransplantation. Aktuell werden, je nach Zentrum, unterschiedliche immunsuppressive Strategien zur Induktions- und Erhaltungstherapie nach Transplantation angewandt. Die Haut bedarf als immunogenste Komponente des Transplantats weiterer Forschung, um mit den Erfolgen der immunsuppressiven Therapie bei transplantierten soliden Organen gleichziehen zu können. Auch die Organpreservation während des Transfers von Spender zu Empfänger stellt ein wichtiges Forschungsgebiet dar. Mit Publikation motivierender funktioneller und ästhetischer Ergebnisse hat sich die zunächst negative Einstellung hinsichtlich dieser nicht überlebensnotwendigen Transplantationen zum Positiven gewandelt. Kontinuierliche Weiterentwicklung chirurgischer Techniken und immunsuppressiver Strategien bilden die Grundlage zur erfolgreichen Etablierung dieses spannenden jungen Verfahrens.

Abstract

Vascularised composite allotransplantation (VCA) is utilised for restoration of complex defects. In this context, restoration describes the replacement of destroyed tissue by identical anatomic structures. Up to date, over 150 VCAs including 31 face transplantations have been performed worldwide. Face transplantation is a life giving, rather than life saving procedure that is intended to significantly improve the patient’s quality of life. Safe revascularisation as well as aesthetic and functional reintegration are the ultimate goals of face transplantation. The necessary lifelong immunosuppression with potentially life-threatening side effects imposes the need for a very strict risk-benefit ratio assessment and currently limits the indications of face transplantation. Different transplant centres use different protocols for induction and maintenance immunosuppression. Skin is the most immunogenic part of the vascularised composite allograft and has been the focus of intensive research efforts in order to replicate the success of immunosuppressive regimens for solid organ transplantation. Organ preservation during transfer from donor to recipient is another important field of research within VCA. The general public’s originally rejecting attitude towards non-lifesaving VCA procedures has changed towards a general acceptance following the publication of promising results after the first cases of face transplantation. Further improvements of surgical techniques and immunosuppressive strategies will be important to drive these young and exciting procedures forward in the future.

Schlüsselwörter

experimentelle Transplan­tation - Koaptation - kraniofaziale Chirurgie - Gesicht - Mikrochirurgie

Key words

experimental transplantation - coaption - craniofacial surgery - face - microsurgery
 

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