手移植和血管化复合组织同种异体移植在矫形和创伤学中的应用。

Hand transplantation and vascularized composite tissue allografts in orthopaedics and traumatology.

机构信息

Department of Orthopaedics and Traumatology, Erasme University Hospital, Université libre de Bruxelles, 808 route de Lennik, 1070 Brussels, Belgium.

出版信息

Orthop Traumatol Surg Res. 2010 May;96(3):283-90. doi: 10.1016/j.otsr.2010.03.003. Epub 2010 Apr 18.

DOI:10.1016/j.otsr.2010.03.003

PMID:20488148

Abstract

Composite tissue allograft (CTA) is defined as heterologous transplantation of a complex comprising skin and subcutaneous, neurovascular and mesenchymal tissue. Such techniques allow complex reconstruction using matched tissue, without donor site morbidity. The potential indications in orthopaedics-traumatology could in the future be more frequent than the present indications of heart, lung, liver, kidney and pancreas transplantation. International clinical experience clearly demonstrates the feasibility of CTA, both surgically and immunologically. However, immunosuppression remains indispensable, exposing the patient to risks that are not acceptable for purely functional surgery, except in very particular indications. The main hope for the future lies in induction of graft-specific tolerance.

摘要

复合组织同种异体移植（CTA）被定义为包含皮肤和皮下组织、神经血管和间充质组织等复杂组织的异体移植。此类技术允许使用匹配的组织进行复杂重建，而不会造成供体部位的发病率。在矫形创伤学中的潜在适应证将来可能比心脏、肺、肝、肾和胰腺移植的目前适应证更为常见。国际临床经验清楚地表明了 CTA 在手术和免疫学方面的可行性。然而，免疫抑制仍然是不可或缺的，这会使患者面临风险，而这些风险在纯粹的功能性手术中是不可接受的，除非在非常特殊的适应证中。未来的主要希望在于诱导移植物特异性耐受。