Composite Tissue Allograft Transplantation of Cephalocervical Skin Flap and Two Ears
Composite Tissue Allograft Transplantation of Cephalocervical Skin Flap and Two Ears
复制标题
DOI：
10.1097/01.prs.0000153038.31865.02
复制
发表时间：
2005-03-01
影响因子：
3.6
通讯作者：
Li, Jie S.
中科院分区：
文献类型：
--
作者：
Jiang, Hui Q.;Wang, Yong;Li, Jie S.
恶性黑色素瘤是最具侵袭性的肿瘤之一，发病率持续增加。1肿瘤易发生增殖和转移，多数病例对化疗耐药。手术切除仍然是原发性和复发性皮肤恶性黑色素瘤的主要治疗方法。达卡巴嗪单药化疗仍然是转移瘤的首选，2因为试验未能证明多药化疗与单药化疗相比或辅助免疫治疗或生物治疗与化疗相比患者的显著生存获益。1，3，4目前，干扰素是唯一美国食品和药物管理局批准的辅助治疗高阶段黑色素瘤，并已显示出不确定的好处在相当大的毒性的代价2，5，6;最佳剂量和治疗持续时间尚未确定正在进行的研究。4，5根治性切除会留下广泛的组织缺损，难以用有限的自体组织重建。全功能和美学重建具有挑战性，很少实现。尽管复合组织同种异体移植的益处与风险是一个争论的问题，但大多数临床医生都同意使其成为临床可行的治疗方法，作为创伤性损失或肿瘤切除后组织替换或重建以及先天性异常修复的理想来源。免疫抑制方案的新进展大大改善了复合组织同种异体移植的结果。人类第一只异体手-
Malignant melanoma is one of the most aggressive tumors, with an incidence that continues to increase. 1 It is liable to proliferate and metastasize with chemoresistance in a majority of cases. Surgical resection remains the primary treatment for cutaneous malignant melanoma both primary and recurrent if possible. Monochemotherapy with dacarbazine is still the first choice for metastases, 2 because trials have failed to demonstrate significant survival benefit in patients treated with polychemotherapy compared with monochemotherapy or in patients treated with adjuvant immunotherapy or biotherapy compared with chemotherapy. 1, 3, 4 At present, interferon is the only US Food and Drug Administration–approved adjuvant treatment for high-stage melanoma and has shown indefinite benefits at the price of considerable toxicity2, 5, 6; the optimal dosage and duration of treatment are yet to be defined by ongoing studies. 4, 5Radical resection will leave extensive tissue defects that are difficult to reconstruct using limited sources of autogenous tissue. Full functional and aesthetic reconstruction is challenging and is only rarely achieved. Although the benefits versus risks of composite tissue allograft transplantation are a matter of debate, most clinicians agree on the goal of making it a clinically feasible treatment that would serve as an ideal source for the replacement or reconstruction of tissues after traumatic loss or tumor resection and for the repair of congenital abnormalities. 7 New advances in immunosuppressive regimens have greatly improved the outcome of composite tissue allograft transplantation. The first human hand allo-