Vascularized Composite Allotransplantation最新文献

{"title":"2582: Bone marrow regulated local protective mechanisms of vascularized composite allografts in non-human primates","authors":"M. Uluer, A. Nam, J. Woodall, Wessam S. Hassanein, D. Bruno, D. Parsell, Urmil Drhu, B. Bojovic, S. Bartlett, R. Barth","doi":"10.1080/23723505.2016.1233035","DOIUrl":"https://doi.org/10.1080/23723505.2016.1233035","url":null,"abstract":"2582: Bone marrow regulated local protective mechanisms of vascularized composite allografts in non-human primates Mehmet C. Uluer, MD, ScM, Arthur J. Nam, Jhade D. Woodall, MD, Wessam Hassanein, MD, David A. Bruno, MD, Dawn Parsell, BS, Urmil Drhu, BS, Branko Bojovic, Stephen T. Bartlett, MD, and Rolf N. Barth, MD University of Maryland School of Medicine, Baltimore, MD, USA; University of Maryland Medical Center, Baltimore, MD, USA Background Vascularized composite allografts (VCA) containing vascularized bone marrow (VBM) prolongs graft survival Cell populations within the co-transplanted VBM are believed to protect the skin and muscle graft components We performed experiments to define these mechanisms in our established non-human primate model of facial transplantation. Methods Three experimental groups were performed of facial VCA Group 1: VCACVBM segments to MHCmismatched cynomolgus macaques after donor irradiation (n D 4) Group 2: VCA without bone C heterotopic VBM without skin (n D 4) Group 3: VCACVBM after donor lymphodepletion with ATGAM (n D 2) Immunosuppression consisted of tacrolimus and mycophenolate mofetil End points were graft rejection or PTLD Chimerism was assayed using donor specific anti-MHC antibodies. Results Group 1 recipients underwent early graft loss (mean 32 § 21 d) from rejection (Banff IV) Chimerism was undetectable in 3 animals Donor VBM demonstrated replacement with recipient cells (50%, 70%, 100%, and 100%) Group 2 recipients also experienced early skin rejection (mean 37§18d), while one animal had PTLD Chimerism was likewise undetectable and heterotopic VBM demonstrated fibrosis and recipient replacement Of the 2 preliminary group 3 recipients one rejected early at day 12, while the other developed PTLD Complete replacement of the bone marrow was seen in the early rejecting animal These data compared to historical VCACVBM grafts with mean survival of 348§ 86 days (rejection only after immunosuppression withdrawal), 75% chimerism, and viable donor VBM. Conclusions Facial VCACVBM contain cell populations that protect the graft from early rejection and graft loss Our data support that these cell populations are radiosensitive, and do not confer systemic protective effects These results support a hypothesis that regulatory cell populations within VBM have local down-regulatory functions toward graft infiltrating alloreactive lymphocytes The finding that cells are noted to be susceptible to depletion or downregulation of their protective effect by irradiation should be kept in consideration when choosing pre-operative conditioning regimens and treating rejection in VCA. CONTACT Mehmet C. Uluer, MD, ScM mculuer@gmail.com © 2016 Mehmet C. Uluer, Arthur J. Nam, Jhade D. Woodall, Wessam Hassanein, David A. Bruno, Dawn Parsell, Urmil Drhu, Branko Bojovic, Stephen T. Bartlett, and Rolf N. Barth. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons At","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122336391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2537: The ischemic limb? A timeline of pathophysiological processes in amputated porcine forelimbs","authors":"N. Krezdorn, Rachel Lopdrup, M. Aycart, Muayyad Alfhefzi, H. Kiwanuka, T. Win, E. Bueno, B. Pomahac","doi":"10.1080/23723505.2016.1234245","DOIUrl":"https://doi.org/10.1080/23723505.2016.1234245","url":null,"abstract":"2537: The ischemic limb? A timeline of pathophysiological processes in amputated porcine forelimbs Nicco Krezdorn, Rachel Lopdrup, Mario A. Aycart, Muayyad Alfhefzi, Harriet Kiwanuka, Thet-Su Win, Ericka Bueno, and Bohdan Pomahac Brigham and Women’s Hospital, Boston, MA, USA Background Tissue ischemic changes after amputation of limbs are dependent on time and can determine the success or failure of replantation and/or allotransplantation. The aim of this study was to elucidate changes that occur in skeletal muscle cells during ischemic conditions imparted by common tissue storage practices. Methods A total of 23 porcine forelimbs were amputated (mean weight 3 kg per limb) and stored under 4 different conditions for 12 h, as follows: a) storage on ice slurry at 4C b) storage on ice slurry at 4C ice after flushing with University of Winsconsin solution (UW), c) ex vivo perfusion with acellular solution at 10C, and d) storage at room temperature. Biopsies of the muscle tissue were taken every 2 h during storage and assessed for histomorphologic changes, apoptosis, glycogen and ATP storage. Results Histopathology did not show significant differences in cellular and tissue structure after 12 h of storage, nor did markers for apoptosis. Staining for intracellular glycogen revealed complete loss of glycogen in groups (a), (b) and (d) after 6 h of storage, whereas glycogen stores remained unchanged in the perfusion group. Total ATP depletion in cold storage samples was noted after 2 h. Conclusion Hypoxia of a duration of up to 12 h does not seem to be immediately lethal for skeletal muscle tissue. Early loss of ATP and depletion of intracelullar glycogen stores were observed even whenmetabolismwas slowed down by cooling to 4C; these may lead to cellular and molecular changes that might be responsible for subsequent damage, injury and cell death after reperfusion. Figure 1. Intracellular glycogen staining with PAS (Periodic acid+Schiff stain) of muscle tissue at the time of amputation (0h) and after 6 h of preservation on ice or in our perfusion device. After 6 h on ice, de-coloration indicates consumed intracellular glycogen and therefore loss of cellular energy supply. CONTACT Nicco Krezdorn nkrezdorn@bwh.harvard.edu Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/kvca. © 2016 Nicco Krezdorn, Rachel Lopdrup, Mario A. Aycart, Muayyad Alfhefzi, Harriet Kiwanuka, Thet-Su Win, Ericka Bueno, and Bohdan Pomahac. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. VASCULARIZED COMPOSITE ALLOTRANSPLANTATION 2016, VOL. 3, NOS. 1–2, 45 http://dx.doi.org/10","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"os-12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127760177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2597: Assessment of engraftment and safety of a new tolerance inducing therapy of human cord blood derived ex-vivo created di-chimeric cells in NOD SCID mouse model","authors":"J. Cwykiel, Natalia Filipek, M. Cyran, C. Baş, E. Szilagyi, Ewa Bryndza Tfaily, M. Askar, M. Siemionow","doi":"10.1080/23723505.2016.1234262","DOIUrl":"https://doi.org/10.1080/23723505.2016.1234262","url":null,"abstract":"2597: Assessment of engraftment and safety of a new tolerance inducing therapy of human cord blood derived ex-vivo created di-chimeric cells in NOD SCID mouse model Joanna Cwykiel, MSc, Natalia Filipek, BSc, Malgorzata Cyran, Can Emre Bas, Erzsebet Szilagyi, Ewa Bryndza Tfaily, Medhat Askar, MD, PhD, and Maria Siemionow University of Illinois at Chicago, Chicago, IL, USA; Cleveland Clinic, Cleveland, OH, USA Background The aim of this study was to evaluate the phenotype, engraftment and safety of ex-vivo fused human cord blood derived di-chimeric cell therapy (DCC) in the NOD SCID mouse model. Methods A total of 36 fusions of human umbilical cord blood (UCB) mononuclear clls were performed UCB from 2 unrelated donors were separately stained with PKH26 and PKH67 dyes Fused with polyethylene glycol, double (PKH26/PKH67) stained DCC were sorted and subjected to the in vitro evaluations (15 fusions): lymphocytotoxicity (LCT) test, PCR-rSSOP, STR-PCR, viability, apoptosis, colony forming unit (CFU) assay and COMET assay DCC (3–5 £ 10 cells) from 18 fusions (n D 6/Group) were delivered: Group 1: intraosseous, Group 2: intramuscular, and Group 3: subcutaneous to the NOD SCID recipient mice Control mice in Groups 4, 5, and 6 (n D 6) received 3 £ 10UCB utilizing the same 3 delivery sites Mice were observed daily for 90 days for changes in weight, activity, posture and hair loss Moreover, mice were evaluated bi-weekly by palpation and at 90 days by magnetic resonance imaging (MRI) The presence of DCC in the blood was determined by complete blood count (CBC) and flow cytometry (FC) The migratory pathways of DCC, peripheral blood, bone marrow and lymphoid organs were assessed at 3 months after delivery using immunofluorescent staining Furthermore, H&E staining was performed to assess harvested tissues for tumor growth. Results The presence of HLA class I and II from both UCB donors was confirmed by LCT, PCR-rSSOP, and STR COMET assay showed no damage to the DNA of DCC following fusion procedure Migratory properties of DCC were confirmed at 24 hours after cell delivery Human derived cells (CD45C, CD19C, HLA class I and CD4C) were detected at a level up to 2% in the peripheral blood as tested by CBC and flow cytometry at 90 days following delivery No DCC derived tumorlike growth was observed. Conclusions Phenotype, engraftment and safety of DCC were characterized The unique concept of supportive therapy of DCC introducing cells presenting phenotype characteristics of both transplant donor and recipient is a new promising approach for tolerance induction and prolonging VCA survival. CONTACT Joanna Cwykiel, MSc jcwykiel@uic.edu © 2016 Joanna Cwykiel, Natalia Filipek, Malgorzata Cyran, Can Emre Bas, Erzsebet Szilagyi, Ewa Bryndza Tfaily, Medhat Askar, and Maria Siemionow. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/lice","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134061584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2603: Ex-vivo graft preservation with hydrogen sulfide and hydrogen iodide for suspended animation of non-human primate (macaca mulatta) upper extremity vascularized composite allotransplants (VCA)","authors":"Kevin Wu, M. Davis, M. Roth, S. Lawson, R. Cindass, J. Spencer","doi":"10.1080/23723505.2016.1234270","DOIUrl":"https://doi.org/10.1080/23723505.2016.1234270","url":null,"abstract":"Abstract : Summary. H2S may play a role in mitigating onset of acute rejection in porcine VCA model in the absence of immunosuppression. Potential use for graft preservation strategies in a clinical setting that may require prolonged ischemic periods.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"119 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120872453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstructive Transplantation for Penile Restoration","authors":"D. Cooney, S. Tuffaha, C. Cooney, G. Brandacher, W. Lee, R. Redett","doi":"10.1080/23723505.2016.1215282","DOIUrl":"https://doi.org/10.1080/23723505.2016.1215282","url":null,"abstract":"Male genitourinary trauma often results in devastating physical and psychological sequellae. Traditional options for autologous reconstruction do not fully restore form and function and are prone to significant complications involving urinary strictures and fistulae as well as prosthesis extrusion; we believe that reconstructive transplantation may provide improved outcomes for select patients. Thus far, penile allotransplantation has been performed twice with mixed results. Prior to more widespread implementation, carefully attention must be directed toward minimizing the benefits and minimizing the risks associated with this procedure. There are also a number of ethical considerations unique to penile transplantation that must be considered. In this article, we review the potential risks, benefits and ethical considerations pertaining to penile transplantation and discuss approaches to optimize outcomes.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126216318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Kidney Transplants to Vascularized Composite Allografts: The Role of the Plastic Surgeon in Transplantation","authors":"T. Welman, V. Villani, K. Shanmugarajah, S. Hettiaratchy","doi":"10.1080/23723505.2016.1197874","DOIUrl":"https://doi.org/10.1080/23723505.2016.1197874","url":null,"abstract":"In 1954, plastic surgeon Dr Joseph Murray performed the first successful organ transplant between identical twins. Today solid organ transplants are performed routinely and offer a curative option for patients with end stage organ failure. For his pioneering work in transplantation biology, Dr Murray remains the only plastic surgeon to have been awarded the Nobel Prize in Medicine. The success of modern day transplants has allowed transplantation to be applied more broadly. In particular, vascularized composite allografts (VCAs), including face and hand transplants, have emerged over the past 15 y. These have been used for reconstruction of patients with extensive disfigurements. Despite these great successes, the use of chronic immunosuppression by transplant recipients is accompanied by the risk of malignancy, organ toxicity and infection. Current research efforts by transplant physicians and plastic surgeons are aimed at reducing and subsequently eliminating the burden of life-long immunosuppression. This review will provide a historical overview of the contributions of plastic surgeons in the development of modern day transplantation. Subsequently we will examine the emergence of vascularized composite allografts. Finally, future directions in which plastic surgeons are contributing to transplant biology are mentioned.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"552 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114635921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Rejection in Vascularized Composite Allotransplantation: More than Just Arguing Semantics","authors":"K. Kolegraff, C. Kaufman, G. Brandacher","doi":"10.1080/23723505.2016.1229650","DOIUrl":"https://doi.org/10.1080/23723505.2016.1229650","url":null,"abstract":"Vascularized composite allotransplantation (VCA), including upper extremity and face transplantation, is increasingly utilized for reconstruction of devastating and disfiguring injuries, with over 200 transplants performed and more reconstructive teams around the world embarking on these reconstructive endeavors. Targeted, immune-mediated tissue destruction or “rejection” is an inevitable challenge of allotransplantation. Recognizing rejection and distinguishing it from other pathologies is essential in order to prevent damage or loss of the allograft. A better understanding of the mechanisms of VCA rejection will help guide the development of treatment and preventative therapies. The patterns of rejection observed in VCA are not well-defined, and a more standardized use of terminology will further our understanding of the process. Here we discuss the clinical and histological features of allograft rejection that have been described to date and review the use of specific terminology to describe features of VCA rejection. Finally, we conclude with several important questions that are central to our understanding of the rejection process.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132786316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Memory T Cells in Vascularized Composite Allotransplantation","authors":"Z. Ng, C. Read, J. Kurtz, C. Cetrulo","doi":"10.1080/23723505.2016.1229649","DOIUrl":"https://doi.org/10.1080/23723505.2016.1229649","url":null,"abstract":"Memory T cells are generated as part of the body's primary immune response to infection and environmental exposure so that a primed and more rapid response can be mounted in subsequent encounters. While beneficial in response to subsequent pathogen exposures, the unique characteristics of memory T cells such as their longevity, distinct trafficking patterns to multiple body sites, and cross-reactivity with donor antigens, have been demonstrated to represent a formidable barrier to successful transplantation and tolerance induction in both animal research models and clinical studies. In the context of vascularized composite allotransplantation (VCA) where acute rejection episodes are frequent despite chronic immunosuppression, current research efforts are directed toward immunosuppression minimization or complete withdrawal of immunosuppression through the attainment of transplantation tolerance. This review focuses on the potential roles of memory T cells on the rejection process at the level of the skin and the outcome of immunologic protocols for tolerance induction in VCA.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124364664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Single Center's Experience with Donation of Facial Allografts for Transplantation","authors":"Anne Huang, E. Bueno, B. Pomahac","doi":"10.1080/23723505.2016.1189992","DOIUrl":"https://doi.org/10.1080/23723505.2016.1189992","url":null,"abstract":"Face transplantation offers superior functional and aesthetic outcomes when compared with conventional reconstruction. Optimizing criteria to match donors and recipients will improve outcomes. However, there is limited available literature regarding donor procurement and matching. The Brigham and Women's Hospital describes its experience with facial allograft donation for 7 face transplants performed between 2009 and 2014. Important considerations include donors' type of death, allograft ischemia time, demographics, immunologic compatibility, serology, and donor facial restoration. Brain-dead, heart-beating donors were preferred because their hemodynamic stability facilitated procurement logistics. The maximum allograft ischemia time allowed by our team was 4 hours. Donor and recipient should be matched in appearance by having the same gender, similar age, and comparable skin tone/texture. Immunologic compatibility requires ABO compatibility, suitable HLA typing, and negative crossmatch. Donor serology for infectious diseases, especially cytomegalovirus (CMV) and Epstein-Barr virus (EBV), is important because of implications of post-transplant immunosuppression. High-risk CMV and EBV matches (donor-positive/recipient-negative) should be avoided when possible. Facial restoration with a prosthetic mask was performed to preserve the donor's dignity. Although every face transplant recipient has unique needs, we hope this report will help identify important donor characteristics that can be incorporated in a national donor registry.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128337628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteosynthesis in Forearm Transplantation Using a Novel Ulnar-Shortening Osteotomy System for Simultaneous Both Bone Fixation","authors":"Shaun D. Mendenhall, Ryan W. Schmucker, M. De la Garza, J. Lutfy, L. Levin, M. Neumeister","doi":"10.1080/23723505.2016.1140617","DOIUrl":"https://doi.org/10.1080/23723505.2016.1140617","url":null,"abstract":"Introduction: Osteosynthesis in forearm-level allotransplantation is technically challenging. Achieving adequate cortical contact simultaneously between the radius and ulna proves difficult due to differing bone morphology of donor and recipient. In addition, the large area of dissection around the osteotomy sites and use of immunosuppressants further deters osseous healing, making nonunion a significant risk. Methods: Seven distal forearm transplants were performed on cadavers using the Newclip Technics ulnar-shortening osteotomy system for both the radius and ulna. The donor bones were plated after placing two transverse 0.062 K-wires distally for DRUJ stabilization. The osteotomy cut-guides were screwed to the plates and oblique osteotomies were performed. Matching recipient osteotomies were performed using the same cut-guide system. The donor and recipient were then brought together and any discrepancies in length corrected. The osteosynthesis site is then compressed and an interfragmentary lag screw placed across the osteosynthesis. Results: The Newclip system enables precise osteosynthesis in cadaver distal forearm transplants. Targeted radial and ulnar lengths are reliably achieved while maintaining accurate control of ulnar variance. Multiple osteotomy slot options on the cut guides allow titration of bone length. Oblique osteotomies enable increased cortical contact and an interfragmentary lag screw for additional stabilization. Conclusions: The capability to perform osteotomies, compression, and fixation of both radius and ulna simultaneously using this technique allows for reliable and precise hand transplantation osteosynthesis. This technique will be an effective tool until patient-specific instrumentation derived from computer-aided design can be expeditiously manufactured and made widely available.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128653267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}