Vascularized composite tissue mandibular transplantation in dogs.
Vascularized composite tissue mandibular transplantation in dogs.
复制标题
狗的血管化复合组织下颌移植。
DOI：
10.1016/s0041-1345(96)00340-5
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发表时间：
1997
影响因子：
0.9
通讯作者：
Sotereanos,GC
中科院分区：
文献类型：
--
作者：
Höhnke,C;Russavage,JM;Subbotin,V;Llull,R;Starzl,TE;Sotereanos,GC
结果10只动物中有9只长期存活。一只狗在2周后被处死，体重下降超过25%。对照犬于1年后处死。一只同种异体移植犬发生肠套叠，18个月后不得不处死。剩下的4只狗在2年半后被处死。所有长期存活的患者都有良好的功能结果，保持了术前体重。只有一只狗的嘴张度减少了。临床上，没有感染或骨连接处不稳定的迹象。x光片和组织学显示移植物完全骨整合。同种异体移植肌肉的组织学检查显示其存活能力。讨论与结论目前实体器官移植已成为标准手术，但CTA仍处于实验阶段。在非血管化骨同种异体移植物中，主要的并发症，不稳定和感染，发生在约25%的移植物中。1与此同时，自体游离骨移植即刻血运重建可改善骨整合。同种异体移植物血运重建术的缺点是免疫原性增加，因此需要免疫抑制。2 Randzio等人3表明，环孢素免疫抑制兔血管化半可食用移植物的长期存活受到中毒性消耗综合征的限制。Gold等4报道了4只猴子中2只半可食用移植的短期存活。我们的研究结果证明，血管化部分下颌骨移植可以在没有明显问题的狗使用他克莫司免疫抑制。移植物长期存活，具有良好的功能结果和组织学结果。该模型具有重要的临床意义和意义。
RESULTSNine of 10 animals became long-term survivors. One dog had to be sacrificed after 2 weeks for weight loss over 25%. The control autograft dogs were sacrificed after 1 year. One allograft dog developed intussusception and had to be sacrificed after 18 months. The remaining four dogs were sacrificed after 2.5 years. All long-term survivors had a good functional outcome, keeping their preoperative weight. Mouth opening was only reduced in one dog. Clinically, there were no signs of infection or instability of the bony junction. X-rays and histology demonstrated complete osseous integration of the grafts. Histologic examinations of the allograft muscles demonstrated viability.DISCUSSION AND CONCLUSIONSCurrently solid organ transplantations have become standard procedures, but CTA is still at the experimental level. In nonvascularized bone allografts the main complications, instability and infections, occur in of about 25% of the grafts. 1 Meanwhile, immediate revascularization of free bone autografts improves osseous integration. Allograft revascularization is combined with the disadvantage of an increase in immunogenecity, thus requiring immunosuppression. 2 Randzio et al 3 showed that long-term survival of vascularized hemimandible grafts with cyclosporine immunosuppression in rabbits is limited by a toxic wasting syndrome. Gold et al 4 reported only short-term survival of hemimandible transplants in two of four monkeys. The results of our study prove that vascularized partial mandible transplantation can be performed in dogs without significant problems using tacrolimus immunosuppression. Long-term graft survival with good functional results and histologic outcome were demonstrated. This model has important clinical relevance and implications.