Experimental and Clinical Experience with Small Composite Tissue Allotransplants and Cryopreservation Techniques

ABSTRACT

Reconstruction surgery requires imagination, inventiveness, and creation-a quest that entails overcoming obstacles never before encountered. Over the past 25 years, with the advent in microsurgery of free revascularized transfers, it was believed that this fundamental breakthrough would be sufficient to resolve difficulties of whatever nature, and that little else would be necessary. Undoubtedly, the results obtained by using free autotransfers have been so remarkable that it is no longer possible to undertake reconstruction in plastic surgery without fully mastering these techniques. Nevertheless, limitations remain, especially with regard to form and shape, as there are areas where form and function merge. As a result, some clinical cases today continue to induce a sense of powerlessness, as was the case 25 years ago when surgeons were presented with large skin defects that are nowadays treated routinely and with a sense of confidence. The sense of powerlessness today clearly signals that another milepost needs to be reached; we believe this milepost should be allotransplantation. Yet allotransplantation should not remain within the realm of the exceptional; on the contrary, it should become routinely accessible. But in order for it to become so, cryopreservation, a pathway that has so far received little attention, and about which much remains to be learned, should be explored. Accordingly, in this article, we report our experience with xenotransplantation, a mainly clinical procedure in the area of hand surgery.

Allotransplantation - composite tissue transfer - tendon - xenotransplantation - cryopreservation - heterotopic revascularization

REFERENCES

• 1 Guimberteau J C, Baudet J, Panconi B et al.. Human allotransplant of a digital flexion system vascularized on the ulnar pedicle: a preliminary report and 1-year follow-up of two cases.  Plast Reconstr Surg. 1992;  89 1135-1147
• 2 Lee W P, Yaremchuk M J, Pan Y C et al.. Relative antigenicity of components of a vascularized limb allograft.  Plast Reconstr Surg. 1991;  87 401-411
• 3 Dubernard J M, Owen E, Herzberg G et al.. Human hand allograft: report on first 6 months.  Lancet. 1999;  353 1315-1320
• 4 Dubernard J M, Owen E R, Lanzetta M et al.. What is happening with hand transplants?.  Lancet. 2001;  357 1711-1712
• 5 Strome M. Human laryngeal transplantation: considerations and implications.  Microsurgery. 2000;  20 372-374
• 6 Hofmann G O, Kirschner M H. Clinical experience in allogeneic vascularized bone and joint allografting.  Microsurgery. 2000;  20 375-383
• 7 Zhang F, Attkiss K J, Walker M et al.. Effects of cryoconservation on survival of composite tissue grafts.  J Reconstr Microsurg. 1998;  14 559-564
• 8 Dubert Th. Etude de la conservation transferts de lambeaux inguinaux cryoconserves et revascularises chez Ie rat. These de Doctorat. Microsurgery Laboratory, Saint Antoine Hospital Paris; 1986
• 9 Hohnke C, Russavage J M, Subbotin V et al.. Vascularized composite tissue mandibular transplantation in dogs.  Transplant Proc. 1997;  29 995
• 10 Yin H, Xiang X, Kim S S et al.. Transplantation of intact rat gonads using vascular anastomosis: effects of cryopreservation, ischaemia and genotype.  Hum Reprod. 2003;  18 1165-1172
• 11 Rendal-Vazquez M E, Maneiro-Pampin E, Rodriguez-Cabarcos M et al.. Effect of cryopreservation on human articular chondrocyte viability, proliferation, and collagen expression.  Cryobiology. 2001;  42 2-10
• 12 Muldrew K, Novak K, Studholme C et al.. Transplantation of articular cartilage following a step-cooling cryopreservation protocol.  Cryobiology. 2001;  43 260-267
• 13 Oh J H, Zoller J, Kubler A. A new bone banking technique to maintain osteoblast viability in frozen human iliac cancellous bone.  Cryobiology. 2002;  44 279-287
• 14 Kreder H J, Keeley F, Salter R. Cryopreservation of periosteum for transplantation.  Cryobiology. 1993;  30 107-115
• 15 Chow S P, So Y C, Chan C W. Experimental microarterial grafts: freeze-dried allografts versus auto grafts.  Br J Plast Surg. 1983;  36 345-347
• 16 Pascual G, Rodriguez M, Corrales C et al.. New approach to improving endothelial preservation in cryopreserved arterial substitutes.  Cryobiology. 2004;  48 62-71
• 17 Hirase Y, Kojima T, Takeishi M et al.. Transplantation of long term cryopreserved allocutaneous tissue by skin graft or microsurgical anastomosis: experimental studies on rat.  Plast Reconstr Surg. 1993;  91 492-501
• 18 Wilmut I. The effect of cooling rate, warming rate, cryoprotective agent and stage of development on survival of mouse embryos during freezing and thawing.  Life Sci. 1972;  11 1071-1079
• 19 Bakhach J, Oufqir A A, Baudet J et al.. Salvage of amputated digits by temporary ectopic implantation.  Ann Chir Plast. 2005;  50 35-42