Artikel
Ultrasound BioMicroscopy (UBM) derived parameters for radiation-free long-term screening after face transplantation
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Autoren
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Maximilian Kückelhaus
- Brigham and Women's Hospital, Harvard Medical School, Division of Plastic Surgery, Boston, Vereinigte Staaten Von Amerika; BG Universitätsklinik Bergmannsheil , Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumore, Bochum, Deutschland
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Sebastian Fischer
- Brigham and Women's Hospital, Harvard Medical School, Division of Plastic Surgery, Boston, Vereinigte Staaten Von Amerika; BG Klinik Ludwigshafen, Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische und Handchirurgie der Ruprecht-Karls-Universität Heidelberg, Ludwigshafen, Deutschland
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Amir Imanzadeh
- Boston, Vereinigte Staaten von Amerika
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Nicole Wake
- Boston, Vereinigte Staaten von Amerika
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Kanako Kumamaru
- Boston, Vereinigte Staaten von Amerika
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Ericka Bueno
- Brigham and Women’s Hospital, Harvard Medical School, Division of Plastic Surgery, Boston, Vereinigte Staaten von Amerika
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Frank Rybicki
- Boston, Vereinigte Staaten von Amerika
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Bohdan Pomahac
- Brigham and Women’s Hospital, Harvard Medical School, Division of Plastic Surgery, Boston, Vereinigte Staaten von Amerika
| Veröffentlicht: | 3. September 2014 |
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Gliederung
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Introduction: While Vascularized Composite Allotransplantation (VCA) is a clinical reality, allograft rejection with tissue loss still remains a concern. The incidence of chronic rejection (CR) is unknown, but is important to monitor since the short-term prognosis is excellent. Since CR may occur with no clinical signs or symptoms, and histology is both invasive and impractical, there is a substantial, unmet need for noninvasive monitoring. Prior data notes changes in intima and media thickness in CR; to date there is no benchmark data after face transplantation. The first purpose of this study is to develop and test high spatial resolution ultrasound methods to measure transplant vessel wall thickness in VCA allografts. The second purpose is to develop a ratio of recipient vs. graft intima thickness as benchmark data.
Method and Materials: A 48 MHz transducer (UBMplus, Accutome, Malvern, PA) was used to acquire images of bilateral facial (FA), radial (RA), dorsalis pedis (DA) and, if applicable, sentinel flap arteries (6 measurements per site, 3 longitudianl plus 3 axial, for a total of 320 scans with 4160 single measurements) in 8 subjects (4 face transplant patients plus 4 controls). Intima, media and adventitia thickness plus lumen and total vessel diameter and area were assessed. Patients were imaged between 8 month and 4½ years after surgery. Mean values were compared between face transplant recipients and controls while accounting for intra-patient correlation.
Results: Patients displayed thicker intima in all sites compared to controls: FA 0.077mm vs. 0.105mm (p=0.069), RA 0.084mm vs. 0.112mm (p=0.084) and DA 0.089mm vs. 0.112mm (p=0.121). The intima ratio between FA (graft) and RA (recipient), named FA/RA-ratio, was not significantly higher in patients compared to controls (1.00092 vs. 0.949959, p=0.742).
Figure 1 [Fig. 1]
Conclusion: Early detection of CR will improve long term face transplant outcomes and globally extend the scope of the intervention. We demonstate that UBM is feasible for post surgical monitoring, and we have developed a new benchmarck parameter for future testing in the setting of CR. The FA/RA-ratio will be correlated with other known metrics of CR. UBM is a radiation free method to supplement established CT and MR methods to assess patients after face transplantation. UBM can also be used for other VCA applications where the tradeoff between high spatial resolution and penetration is favorable.
