Artikel
Utility of sentinel flaps in assessing facial allograft rejection
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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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Christine Lian
- 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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Francisco Marty
- Boston, Vereinigte Staaten von Amerika
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Stefan Tullius
- Boston, Vereinigte Staaten von Amerika
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Julian Pribaz
- Boston, Vereinigte Staaten von Amerika
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George Murphy
- 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: Skin biopsies are critical for histological evaluation of rejection and proper treatment after facial allotransplantation (FAT). Many facial allografts provide only limited skin area and frequent biopsies may additionally compromise aesthetic outcome. In these cases, sentinel flaps (SFs), recovered as a free fasciocutanous radial forearm flap, have been employed for remote site rejection monitoring. These flaps maintain their axial blood supply similar to facial allografts. The correlation between FAT and SF in cases of rejection is presented.
Methods: We analyzed the experience of the Boston team’s employment of 4 SFs. Biopsies from both FAT and SF were taken using a standard 4mm punch biopsy from the most erythematous area of the allograft. Rejection was evaluated and the results compared for each time point. The SFs where used as functional flap whenever possible (e.g. to release a contracture).
Results: The results show a reliable correlation between biopsies taken from the facial allograft (FA) and SF. During severe rejection episodes in 100% of the biopsy pairs both sites displayed a similar grade of rejection. In one case the clinical findings suggested rejection in the FA but were unraveled as Rosacea, since clinically there was no rejection displayed in the SF. In 3 of the 4 patients the location of the flap inset was selected for a release of hand first web space contracture or coverage of unstable scars.
Figure 1 [Fig. 1]
Discussion: The utilization of a SF can prevent impairment of aesthetic outcomes in FAT. SF showes a reliable correlation to the FA in cases of severe rejection and therefore provides a valuable tool for rejection monitoring in FAT. Moreover, it can be used to discern clinical signs of rejection by helping to differentiate from facial erythematous conditions related to other causes such as Rosacea. If the FA contains limited skin surface or cannot be used for biopsies due to presence of active opportunistic infections triggered by the immunosuppression, the SF is especially valuable as biopsy site to monitor rejection in the FA. The SF can moreover be employed as functional flap, if applicable.
