Page 93 - Read Online

Page 4 of 10 Wang et al. Plast Aesthet Res 2018;5:10 I http://dx.doi.org/10.20517/2347-9264.2017.90

Eleven rat animal models for face transplant were reported in the literature. Nine of the reports were allografts
and 2 were syngeneic. Ten reports were orthotopically transferred and 1 with heterogenic transplantation.
Various face transplant components were reported ranging from ear, scalp, face, mystacial pad or mandible
with tongue transplantation. A combination of cyclosporin A or tacrolimus was used in these animal models.
Four of these reports had nerve coaptation which looked at the functional recovery in allograft especially
using mystacial pad transplantation.

Two reports of murine orthotopic face transplant were reported with either a hemiface or ear allograft.
No immunosuppressive regimens were used in these reports with more focus on the surgical technique of
transferring an ear or hemiface. The information is presented in Table 1.

Abdominal wall transplantation models
Abdominal wall transplantation comprising of various tissue types also constitutes a vascularized
composite allotransplantation model. All reported models thus far have been carried out in rats across
MHC mismatched rats from Brown-Norway to Lewis rats. The abdominal wall transplants were orthotopic
with 2 hemi-abdominal wall transplants and 1 with the inclusion of a hindlimb transplant. One report
had a total abdominal wall allograft transplanted. Anti-lymphocyte serum was used in 2 of the reports for
induction therapy. Two reports utilized cyclosporine and 1 in combination with adipocyte derived stem
cells intravenously. The models do not include all nerve anastomoses and mixed chimerism all at once. The
information is presented in Table 2.

Penile transplantation models
Penile allograft transplantation models have been described in four articles, all of which have been performed
in rats. Two studies were syngeneic rats, 1 of which was orthotopic and 1 heterotopic. These studies were
focused on the surgical model and being syngeneic grafts, no immunosuppression was used. Anastomosis
of the penile artery and vein was key in each model and ensuring the conduit of the urethra was restored.
The other 2 studies used allografts and heterotopically transplanted penile grafts. One of the studies used
tacrolimus and the other cyclosporin A. The information is presented in Table 3.

Uterus transplantation models
Uterus transplantation has been touted as a method of restoring fertility but functionally must perform as
required. Three articles report uterus transplantations in primates, 7 in sheep, 2 in rabbits, 6 in rats and
3 in murine models. The function of the transplanted uterus was tested in rabbits, rats and mice which
were successful in 3 of the studies. In primate uterus transplantation, various types of immunosuppressive
regimens were used including tacrolimus, mycophenolate mofetil and methylprednisolone as maintenance
regimes. Another protocol utilized ATG as an induction agent followed by tacrolimus and corticosteroids as
maintenance. The information is presented in Table 4.

Hindlimb transplantation models
Hindlimb transplantation has been a model to mimic hand transplantation where components of bone,
muscle, nerve, fat and skin are included in a hindlimb. The animal models demonstrated here to explore
the feasibility of modulating the immunosuppressive regimen in improving the viability of hindlimb
transplants. When transplanted orthotopically, they also serve as a model to assess the functional recovery of
the hindlimb when used for gait. The nerve recovery is crucial in improving the function of the transplanted
allograft. The information is presented in Table 5.

Myocutaneous tissue transplantation models
Soft tissue alone with varying tissue types including fat, connective tissue and muscle are collectively known as
myocutaneous flaps in free flap transplantation. The varying antigenicity of the tissue types is what constitutes