• Archives of Plastic Surgery
• /
• 제35권4호
• /
• pp.367-372
• /
• 2008

Purpose: Prevention of acute rejection in skin allografts without continuous immunosuppression lacks reports in worldwide literature. Needs for chronic immunosuppression preclude the use of tissue allograft as a routine surgical reconstructive option. Recently dendritic cells(DC) gained considerable attention as antigen presenting cells that are also capable of immunologic tolerance induction. This study assesses the effects of alloantigen-pulsed dendritic cells in induction of survival increase in a rat skin allograft model. Methods: Recipient-derived dendritic cells were harvested from rat whole blood and cultured with GM-CSF(200 ng/mL) and IL-4(8 ng/mL) for 2 weeks. Then donor-specific alloantigen pulsed dendritic cells were reinjected into tail vein before skin graft. The rat dorsal skin allografts were transplanted in 5 subgroups. Groups: I) untreated, II) anti-lymphocyte serum(ALS, 0.5 mL), III) FK-506(2 mg/kg), IV) DCp, VI) DCp and FK-506. Graft appearance challenges were assessed postoperatively. Results: The group V(DC and FK-506 treated) showed longest graft survival rate(23.5 days) than other groups; untreated(5.8 days), ALS(7.2 days), FK-506 (17.5 days), DCp(12.2 days). Conclusion: Donor antigen pulsed host dendritic cell combined with short-term immunosuppression prolong skin allograft survival and has potential therapeutic application for induction of donor antigen specific tolerance.

• KSBB Journal
• /
• 제23권1호
• /
• pp.8-17
• /
• 2008

There are many different approaches to healing of acute and chronic ulcer and large skin defect, such as burn. Currently available wound covers fall into two categories. Permanent covering, such as autografts, and temporary ones, such as allograft including de-epidermized cadaver skin, bioartificial skin, xenografts, and synthetic dressings. Autologous skin grafting in the form of split- or full-thickness skin is still the good standard. Following on from developments in the 1980s involving the use of cultured keratinocyte grafts in wound healing, the last decade has been great progress in the fabrication of composite bioartificial skin grafts. However, two bottleneck on producing cultured bioartificial skin, whether of the simple epithelial cell sheet type, or the more complex composite type, continue to be the generation of sufficient keratinocytes cheaply and quickly and develop biocompatible dermal scaffolds. This article covers the development, clinical application, and current research directions associated with bioartificial skin.

• 대한기관식도과학회지
• /
• 제7권2호
• /
• pp.128-139
• /
• 2001

The purpose of this study was to review the literatures of experimental tracheal reconstruction. Although there have been significant advancements in the surgical treatment of the long circumferential tracheal injuries, there still has been a difficult problem with high morbidity and mortality. The method for tracheal reconstruction after circumferential resection is preferred end-to-end anastomosis for defects up to 6 cm in length, but larger tracheal defects require the use of tracheal allograft, various artificial prosthesis or autogenous organs. The tracheal allotransplantation has been widely used as there was significantly improved the method of surgical technique, preservation and immunosuppression. But it has been limited by a number of factors such as few donor, limited use of immunosuppressant, delayed revascularization and re-epitheliazation. Experimental studies on the tracheal prosthesis have a long history and they tried to use silicone, polytetrafluoroethylene, polypropylene mesh, Dacron, Marlex mesh, external or internal stents. Other experimental studies were reported the use of autogenous tissues that were cartilage. jejunum, aorta, skin, muscle, periostium or esophagus. But a great variety of these protheses have been resulted unsatisfactory in a significant Proportion of cases. Alternatively, the tissue-engineering technique has showed a new approach to reconstruct trachea and much progress in tissue-engineering bas been made recently. In conclusion, although the tracheal allotransplantation and the use of prosthesis and allograft have been reported a lot of limitation to overcome, we could sooner expect good result of ideal tracheal prosthesis.

• 대한골관절종양학회지
• /
• 제12권2호
• /
• pp.165-170
• /
• 2006

저자들은 근위 경골에 발생한 연골 육종 환자의 동종골 이식술을 이용한 수술적 치료후 만족할 만한 결과를 얻어 보고하고자 한다. 자기 공명 영상에서 종양의 크기는 $3.5{\times}20$ cm 이었고 적절한 수술연을 선택하여 광범위 절제술을 시행하였으며 결손부는 동종 골이식술 및 내측 비복근 회전 피판술 및 부분 층 피부 이식을 통하여 재건하였다. 최종 추시일 까지 국소 재발이나 원격 전이는 관찰 되지 않았으며 이차 감염이나 불유합, 금속물의 해리 등의 합병증도 발생하지 않았다. 또한 적절한 재활 운동을 통해 만족할 만한 슬관절 관절 운동을 얻을 수 있었다.

• 대한족부족관절학회지
• /
• 제15권4호
• /
• pp.201-206
• /
• 2011

Purpose: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. Materials and Methods: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. Results: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). Conclusion: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.

• IMMUNE NETWORK
• /
• 제2권3호
• /
• pp.133-136
• /
• 2002

Background: The costimulatory molecule 4-1BB, a member of nerve growth factor receptor/tumor necrosis factor (NGFR/TNFR) super family, is involved in cell survival and death. Methods: In this study, female C57BL/6 ($H-2^b$) mice were used as a recipient, and DBA/2 ($H-2^d$) as a donor to assess a mixed lymphocyte reaction (MLR) and CTL response in vitro, and skin graft survival. IL-2, IFN level was measured by ELISA. Results: Mixed lymphocyte reaction (MLR) analysis showed that 4-1BB-deficient responder cells showed enhanced cellular proliferation over littermate controls. In contrast, IL-2 production was diminished only in 4-1BB knockout cultures. The IFN expression, on the other hand, was comparable between the groups. When female C57BL/6 ($H-2^b$) mice were grafted with the trunk skin of DBA/2 ($H-2^d$) mice, the in vivo tissue destruction of 4-1BB-deficient mice was not distinct from the normal littermates. Conclusion: These data suggest that 4-1BB is critical for the induction of alloreactive responses in vitro but 4-1BB alone could not change the course of skin rejection in vivo.

• 대한족부족관절학회지
• /
• 제28권3호
• /
• pp.107-110
• /
• 2024

Neuropathic arthropathy (Charcot arthropathy) is a progressive joint disease often associated with conditions such as diabetes, leading to severe joint deformity and pain. However, its occurrence in patients with rheumatoid arthritis (RA) is rare and not well documented. This case report describes a 48-year-old woman with a long history of RA who developed a severe deformity of her right ankle, identified as neuropathic arthropathy extending to the subtalar joint (Brodsky classification type 3A). After excluding other potential causes, the condition was determined to be secondary to RA-associated peripheral neuropathy. Surgery, including allograft and autograft fixation, was performed to correct the deformity. Post-operative complications, such as wound infection, were treated with negative pressure wound therapy and skin grafting. At the 18-month follow-up, the patient was able to walk without pain, demonstrating successful joint fusion.

• Molecules and Cells
• /
• 제46권11호
• /
• pp.688-699
• /
• 2023

We set up this study to understand the underlying mechanisms of reduced ceramides on immune cells in acute rejection (AR). The concentrations of ceramides and sphingomyelins were measured in the sera from hepatic transplant patients, skin graft mice and hepatocyte transplant mice by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Serum concentrations of C24 ceramide, C24:1 ceramide, C16:0 sphingomyelin, and C18:1 sphingomyelin were lower in liver transplantation (LT) recipients with than without AR. Comparisons with the results of LT patients with infection and cardiac transplant patients with cardiac allograft vasculopathy in humans and in mouse skin graft and hepatocyte transplant models suggested that the reduced C24 and C24:1 ceramides were specifically involved in AR. A ceramide synthase inhibitor, fumonisin B₁ exacerbated allogeneic immune responses in vitro and in vivo, and reduced tolerogenic dendritic cells (tDCs), while increased P3-like plasmacytoid DCs (pDCs) in the draining lymph nodes from allogeneic skin graft mice. The results of mixed lymphocyte reactions with ceranib-2, an inhibitor of ceramidase, and C24 ceramide also support that increasing ceramide concentrations could benefit transplant recipients with AR. The results suggest increasing ceramides as novel therapeutic target for AR, where reduced ceramides were associated with the changes in DC subsets, in particular tDCs.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제32권3호
• /
• pp.189-199
• /
• 2006

Purpose of study: Partial thickness skin graft is the golden standard regimen for full-thickness skin defect caused by burn or trauma. However, in case of extensive burns of more than 50% of total body surface area, the donor site is not sufficient to cover all defects. As a second choice, allograft, xenograft and synthetic materials have been used to treat skin defect. Among them the amniotic membrane(AM) was used as a biological dressing for centuries because of its potential for wound healing. In this study, quantification of EGF in AM and effect of AM-collagen complex on full thickness skin defects was examined. Materials & Methods: The concentration of EGF in fresh, deep frozen and freeze-dried AM was evaluated by ELISA. EGF-R immunostaining was performed in freeze-dried AM. SD rats weighing 250${\sim}$300g was used for wound healing experiment. Three full thickness skin defects(28mm diameter) were made on dorsal surface of SD rat. The control group was covered by Vaselin gauze and AM-collagen complex and $Terudermis^{(R)}$. was grafted in two other defects. Healing area, Cinamon's score were evaluated before biopsy. Grafted sites were retrieved at 3 days, 1 week, 2 weeks and 4 weeks after operation. H & E and Factor VIII immunohistochemical stain was performed to evaluate the microscopic adhesion and structural integrity and microvessel formation. Results: 1. EGF concentration of fresh, deep frozen and freeze-dried AM showed similar level and EGF-R was stained in epithelial layer of freeze-dried AM. 2. At 4 weeks after grafting, the healing area of AM-collagen and Terudermis group was 99.29${\pm}$0.71% and 99.19${\pm}$0.77 of original size. However, that of control group was 24.88${\pm}$2.90. 3. The Cinamon's score of AM-Collagen and $Terudermis^{(R)}$. group at 4 weeks was 15.6${\pm}$1.26 and 14.6${\pm}$3.13 and that of control group was 3.7${\pm}$0.95. Significant difference was observed among control and experimental groups(p<0.05). 4. Histologic examination revealed that AM protected leukocyte infiltration and epithelial migration was nearly completed at 4 weeks. $Terudermis^{(R)}$. group showed mild neutrophil infiltration until 2 weeks and completion of epithelization at 4 weeks. Control group showed massive leukocyte infiltration until 4 weeks. 5. Microvessels were increased sharply at 1 week and control group at 1 and 4 week showed significant differences with $Terudermis^{(R)}$. group of same interval(p<0.05) but no differences were found with AM group(p<0.05). Conclusion: EGF and EGF-R were well preserved in freeze-dried AM. AM attached to collagen acted as excellent biologic dressing which had similar effect with $Terudermis^{(R)}$. AM showed anti-inflammatory action and healing was completed at 4 weeks after full-thickness skin defect.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제35권5호
• /
• pp.342-351
• /
• 2013

Advances in immunosuppressive treatments and microsurgical techniques have rendered composite tissues allotransplantation (CTA), such as heteregeneous or non-organ tissues, possible in humans. CTA has evolved dramatically since the first successful rat hind limb allotransplantation. Numerous clinical applications including face, hand, trachea, larynx, and vascularized joint have been performed. Although composite tissue allografts are still in their infancy, they have opened a new era in the field of transplantation surgery and pathology, so that maxillofacial reconstructive surgeons may occasionally be faced with the challenge of diagnosing skin refection of a composite tissue allograft. Facial allotransplantation (FAT) is a new surgical technique that could be considered as a new paradigm in facial reconstruction. Since the first human FAT had been achieved in 2005, 17 cases have been reported in the world up to date. However, many problems such as life-long immunosuppression, immune rejection, ethical problems and psychological problems are remained, so facial CTA is new reconstructive option with no general acceptance. The authors reviewed the indications, the results of 17 cases and their complications, and additional consideration factors in this article, and intended to raise the awareness of oral and maxillofacial surgeons in this type of facial transplantation.