推进血管化复合异体移植:上肢移植项目发展的基本要素

Martin Kumnig, Caroline Kobler, Alessandra Zaccardelli, G. Brandacher, Simon G. Talbot
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引用次数: 0

摘要

血管化复合体同种异体移植(VCA)为肢体缺失或面部创伤后的外形和功能恢复提供了一种独特的选择,传统的假肢或重建手术无法令人满意地实现这一目标。建立一个成功的上肢移植(UET)项目需要强有力的领导、结构化的手术团队以及广泛的跨学科合作。我们对 12 名医护人员和患者进行了一项定性研究。我们按照协议获得了知情同意,并在线进行了半结构化访谈和录音。参与者报告了他们对有利于或阻碍成功结果的因素的看法,包括手术前后的功能状态、移植前的准备、共同决策、康复和社会心理支持。专题分析表明,在实施自愿造血干细胞移植手术之前,建立一个由不同学科组成的团队至关重要。确定共同目标和选择明确的领导者是手术成功的关键因素,这需要超越常规的开放式合作。所描述的主要类别包括:VCA 团队的跨学科合作和技能、建立和领导 VCA 团队、移植前程序、移植后课程以及建立计划时应考虑的因素。团队科学的基本作用在建立自愿者援助计划中发挥着重要作用。移植医学涉及各种相互重叠的科学和医学范畴,需要医护人员有意识地通力合作,在团队之间建立复杂的纵向和横向沟通网络,以取得积极的成果。除了医学方面的考虑因素外,病人的具体因素,如透明的沟通、治疗计划的制定、计划的坚持和持续的跟踪,也是取得整体成功的重要因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Advancing vascularized composite allotransplantation: essential factors for upper extremity transplant program development
Vascularized Composite Allotransplantation (VCA) offers a unique option to restore form and function after limb loss or facial trauma that cannot be satisfactorily accomplished through traditional prosthetics or reconstructions. Establishing a successful Upper Extremity Transplantation (UET) program requires strong leadership and a structured surgical team, and extensive interdisciplinary collaboration. We conducted a qualitative study among 12 health care professionals and patients. Informed consent was obtained per protocol, and semi-structured interviews were conducted online and recorded. Participants reported their perceptions of factors that either favored or hindered a successful outcome, including functional status before and after surgery, preparation for transplant, shared decision-making, rehabilitation, and psychosocial support. Thematic analysis revealed that it is essential to establish a team comprising various disciplines well before performing VCA procedures. Defining a common goal and choosing a defined leader is a key factor in procedural success and requires open collaboration beyond what is typical. Primary described categories are interdisciplinary collaboration and skills of the VCA team, building and leading a VCA team, pre-transplant procedures, post-transplant course, and factors to consider when establishing a program. The basic roles of team science play an outsized role in establishing a VCA program. Transplantation medicine involves various overlapping scientific and medical categories requiring health professionals to consciously work together to establish complex vertical and horizontal communication webs between teams to obtain positive outcomes. In addition to medical considerations, patient-specific factors such as transparent communication, therapy plan establishment, plan adherence, and continual follow-up are significant factors to overall success.
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