Ghanem A M, Borg T-M, Sadigh P, Myers S, Smith D J, Holmes S
Queen Mary University of London, London, UK.
Department of Plastic and Reconstructive Surgery, The Royal London Hospital, London, UK.
Ann Burns Fire Disasters. 2019 Dec 31;32(4):308-320.
Facial composite tissue allotransplantation (CTA) is a powerful reconstructive option in cases of extensive severe facial injury and tissue loss. Despite the risk of allograft rejection and the post-operative need for lifelong immunosuppression, facial CTA can be used to restore the normal structural appearance and function of the face. Areas of socioeconomic deprivation and armed conflict zones have a high preponderance of patients with facial burns and other severe injuries. However, these regions often also suffer from lack of resources, expert surgical care and limited facilities. The purpose of this manuscript is to provide a comprehensive review of key principles relevant to facial CTA and their potential applicability in such austere environments. We present a concise literature review of the surgical and immunological basis of facial CTA aimed at the plastic surgery readership, as well as issues surrounding organ transplantations in low- and middle- income countries. We then consider the particular challenges posed by austere settings and countries of active armed conflict and discuss how these may impact the suitability of facial CTA for treating severe facial injuries in these circumstances. Facial CTA is recognised as giving huge benefits for patients with severe facial defects with potentially superior results compared with conventional autograft techniques. Its performance in austere settings is limited by scarce resources and increased pre-, intra- and post- operative risks. However, a case can be made for its use even in these more challenging situations when general organ transplantation compliance and expertise input have been addressed.
面部复合组织异体移植（CTA）是广泛严重面部损伤和组织缺损病例中一种有效的重建选择。尽管存在同种异体移植排斥的风险以及术后需要终身免疫抑制，但面部CTA可用于恢复面部的正常结构外观和功能。社会经济贫困地区和武装冲突地区面部烧伤及其他严重损伤的患者比例很高。然而，这些地区往往还面临资源匮乏、缺乏专业外科护理和设施有限的问题。本手稿的目的是全面综述与面部CTA相关的关键原则及其在这种严峻环境中的潜在适用性。我们针对整形手术读者群体，对面部CTA的外科和免疫学基础以及低收入和中等收入国家器官移植相关问题进行了简要文献综述。然后，我们考虑了严峻环境和现役武装冲突国家所带来的特殊挑战，并讨论了这些挑战如何影响面部CTA在这些情况下治疗严重面部损伤的适用性。面部CTA被认为能为严重面部缺陷患者带来巨大益处，与传统自体移植技术相比可能有更优的效果。其在严峻环境中的应用受到资源稀缺以及术前、术中和术后风险增加的限制。然而，即使在这些更具挑战性的情况下，当解决了一般器官移植的依从性和专业知识投入问题后，仍可考虑使用面部CTA。
