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chemical and electrical burns), gunshot trauma, animal multiple biopsies and monitoring of clinical and pathological
bites, plexiform neurofibromas of the trigeminal nerve in signs of graft rejection. [1,48]
the context of neurofibromatosis type I, tumoral sequelae,
severe side effects of radiotherapy, vascular tumors, and Prevention and treatment of rejection
occupational traumas. However, it must be highlighted that Immunosuppressive therapy in patients with FT has been
[43]
since the first full FT performed in 2010, the spectrum similar to the scheme used in solid organ transplantati
of possible candidates has expanded. In general, patients on. [43,52,54,66,75] It consisted of an “induction” phase, which
with significant medical comorbidity, lack of guarantee for starts at an early stage of surgery, followed a “maintenance”
post-transplant monitoring, high risk of recurrent cancer phase. Most teams employed an induction therapy with
under immunosuppression, and pregnancy are excluded. polyclonal anti-thymocyte globulins, monoclonal antibody
[49]
Protocols considered only stable psychological and anti-interleukin-2 receptor as daclizumab and basiliximab,
immunologically patients as potential recipients. [50,56] anti-CD3 monoclonal antibodies, mycophenolate mofetil,
methylprednisolone, and tacrolimus (anti-calcineurin
Patients with plexiform neurofibromas associated with inhibitor). Maintenance and preventing rejection of allograft
[76]
neurofibromatosis type 1 are possible candidates in the is based today on the use of a global immunosuppression
absence of viable reconstructive options. To date, 4 patients induction, non-specific, by postoperative triple therapy
with neurofibromatosis have undergone FAT. [40,51,55] However, consisting of the administration of mycophenolate mofetil,
this procedure should still be considered as an experimental tacrolimus and prednisolone. [77]
option and consequently these patients as well as cancer
patients must be carefully selected. This immunosuppressive regimen should continue during
the life of the patient, which carries risks of toxicity and
Evolution from partial to full FT complications like infections (opportunistic infections
All FT had been partial before the first full FT which by cytomegalovirus, herpes, etc.), metabolic (diabetes),
included different aesthetic units of the face (Barcelona, nephrotoxicity, hypertension and malignancies. Although
[54]
Spain, 2010). [43,65] After the first full FT there was a change theoretically there is a risk of chronic rejection, most
in the reconstructive paradigm because of adherence to teams have not reported evidence of chronic rejection over
the classical concepts of facial aesthetic to a FT. From that time. [72,78,79] Recently there is a report of chronic rejection in
moment, most FT was complete. This full FT approach has a patient who left immunosuppression due to a malignant
proven effective and safe, and most teams have reported process. [3]
excellent anatomical and functional results. [66-68] Moreover,
the restoration of a full new anatomy of the face allowed New strategies of immunosuppression
conventional cosmetic procedures of refinement.
Current research is focused on finding new
immunosuppressive molecules that allow adjustment of
INMUNOLOGY
known drugs and avoid the problems associated with
allograft rejection. Research are mainly directed on
The skin is the most important and largest component of antibodies anticell-T, the development of more selective
FAT, and it is well known that the skin (and the mucosa) molecules with less toxicity to organs (kidney, liver) and
has a high immunogenicity, so it is inevitable that rejection creating a state of hematopoietic chimerism. In addition,
episodes are triggered at different times: [33,69] in the early new immunosuppressant associations are being studied to
period (hyper-acute rejection), within days or months after reduce the doses of each. Some researchers have used bone
transplantation (acute rejection) or chronic rejection. [55,70]
marrow infusion, thymoglobulin, anti-IL-2 receptor antibody
Hyper-acute graft rejection has not been reported so far. and irradiation of X-rays. Since the skin is the more antigenic
However, most recipients had acute rejection episodes in portion of allograft, topical treatment with tacrolimus
the first year, revealed as skin redness, swelling and nodules ointment and phototherapy has also been used. [34,80]
and papules. [54,71,72] In FAT, episodes of mild rejection may
be easier to treat than in solid organ transplantation due RESULTS AND COMPLICACIONS
to immediate visibility of the skin and easy inspection.
Episodes of acute rejection were usually reversible with Functional and aesthetic results
corticosteroids (bolus treatment), supplemented in some FT aims to re-establish the functions of speaking, swallowing
cases by topical drugs (steroids and tacrolimus). [1,55] Other and mimic muscle mobility as well as to provide aesthetic
treatments included the increased tacrolimus levels and improvements that allow patients to live a normal social
topical drugs. [39,50,51,73] life. Although a systematic analysis of all cases cannot
be performed due to the unique characteristics of each
For monitoring rejection episodes after transplantation, patient, the results of the earliest FT, as a whole, are very
clinical systematic follow up is required performing skin convincing. [81]
and/or oral mucosa biopsies. [69,74] In some cases, a sentinel
free flap has been transplanted into donor for carrying out Unlike solid organ transplants, in which a metabolic
214 Plast Aesthet Res || Volume 3 || June 24, 2016