Análise bioética do transplante de face no Brasil / Bioethical analysis of face transplantation in Brazil

INTRODUÇÃO: Atualização sobre os aspectos bioéticos do transplante facial. Estudo de revisão da literatura sobre a situação atual dos transplantes de órgãos e de face, a importância da face humana, e a face humana como órgão vital. MÉTODOS: Revisão bibliográfica narrativa com análise documental acerca dos transplantes de face nos últimos 10 anos. RESULTADOS: Na base de dados PubMed foram encontradas 8259 publicações com a palavra-chave em face transplantation, face transplantation and bioethics em 28 artigos e em organ transplant ethics em em 4877 publicações; documentos relacionados à legislação encontrados na ABTO (Associação Brasileira de Transplantes de Órgãos). CONCLUSÃO: A experiência dos países com o transplante de face demonstrou que é uma opção viável para reconstrução de graves lesões faciais, entretanto, é considerado um procedimento experimental com alto risco de complicações, altos custos, envolve equipe multidisciplinar e a necessidade do uso vitalício de imunossupressores. Até o momento, é indicado para um pequeno grupo de pacientes. Do ponto de vista bioético, vale contextualizar que, apesar da obtenção do termo de consentimento, é necessário avaliar qual é o nível de risco aceitável para o participante da pesquisa. Quem será o responsável pelos custos relacionados ao procedimento? Quando os recursos públicos podem ser utilizados para justificar os direitos individuais em detrimento dos direitos públicos?

INTRODUCTION: This update on bioethical aspects of face transplantation reviews the literature on the current status of organ and face transplantation, the significance of the human face, and the human face as a vital organ. METHODS: This was a narrative bibliographic review, with documentary analysis of face transplantation in the last 10 years. RESULTS: A search of the PubMed database identified 8,259 papers with the keyword face transplantation, 28 articles with the keywords face transplantation and bioethics, and 4,877 papers with the keyword organ transplant ethics; documents related to legislation were found in the Brazilian Association of Organ Transplantation (Associação Brasileira de Transplantes de Órgãos - ABTO). CONCLUSION: The experience of countries where face transplantation has been performed has shown that this is a viable option for the reconstruction of severe facial lesions. However, face transplantation is considered an experimental procedure with high risk of complications and costs, and requires a multidisciplinary team and the lifetime use of immunosuppressants. To date, this procedure is only indicated for a small group of patients. From a bioethics standpoint, it should be noted that, despite providing consent, the level of risk acceptable to the recipient must be assessed. Who will be responsible for the costs related to the procedure? When can public resources be used to justify individual rights over public rights?

Uso de cuero cabelludo como zona donadora de injertos cutáneos de espesor parcial / Use of the scalp as a donor area for partial thickness skin grafts

Objetivo: Demostrar los beneficios del uso de cuero cabelludo como área donadora de injertos cutáneos de espesor parcial. Método: Estudio retrospectivo descriptivo realizado de 2013 a 2015 en la Unidad de quemaduras pediátricas del hospital Roosevelt de 111 pacientes en que se utilizaron injertos del cuero cabelludo. Resultados: La mayoría de los pacientes sufrieron quemaduras por inmersión en líquidos calientes con disponibilidad limitada de zonas donadoras de injertos. El otro uso que se le dio a los injertos de cuero cabelludo fue en quemaduras y lesiones faciales debido a la similitud de la pigmentación de estas áreas. Este estudió demostró el corto tempo de epitelización de esta zona donadora (3.5 días), lo que permitió que se utilizara en varias ocasiones. La principal complicación fue la alopecia (1.8%) resultado de una toma de un injerto muy grueso. Conclusión: El estudio sugiere que el cuero cabelludo es una zona donadora útil cuando las principales áreas donadoras están limitadas. Más investigación tendrá que realizarse para establecer otros beneficios observados del uso de esta región como zona donadora de injertos cutáneos.

Objectve: Demonstrate the benefts of using scalp as a donor area of partal split thickness skin grafs. Methods: Retrospectve descriptve study from 2013 to 2015 shows 111 patents that required a skin graf from the scalp in a pediatric burn unit. Results: Most of the patents were burn victms, but few other cases are described as well. The most common use of this donor area was for patents that had sufered pot immersion scalds where the back, gluteus and lower limbs were afected and no longer available as skin donor areas. The other main use was in facial burns and traumas, because the color similitude between the face and scalp renders a beter cosmetc result of facial skin grafs. This study demonstrates the short period of healing (3.5 days) of the donor area making possible its reuse in a shorter period of tme. The main complicaton was alopecia (1.8%) where the graf take was too deep. Conclusions: The study suggests the use of scalp donor area when other main donor areas are not available and for facial burns. Further studies should be performed in order to establish other observed benefts of the scalp as a donor area for split thickness skin grafs.

Facial Transplantation Surgery Introduction

Severely disfiguring facial injuries can have a devastating impact on the patient's quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie "Face/Off" have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea.

Face transplantation in rats. Reproducibility of the experimental model in Brazil

PURPOSE: To investigate the reproducibility of the experimental model of face allotransplantation in rats in Brazil. METHODS: Eighteen rats were operated, nine-nine donors recipients. Animals underwent transplantation of the left hemiface, with periorbital and scalp. Transplants were made from donor Wistar rats to recipients Lewis rats. Flaps were based on the common carotid artery and the external jugular vein of the donor animal and the anastomosis in the recipient area was performed in common carotid artery (end-to-side) and in external jugular vein (end-to-end). RESULTS: Of the nine recipient animals operated, six survived and three progressed to death in the first days after surgery (survival rate = 67%). The mean time of the procedure was 252 minutes and the mean time of flap ischemia was 95 minutes. The five surviving animals were sacrificed at 14 days, in good general condition and without signs of tissue rejection. CONCLUSIONS: The experimental model of face allotransplantation in rats is reproducible in our midst. Duration of surgery, time of flap ischemia, animal survival rate and complications observed were similar to those described in the literature. .

Estudio morfométrico de la región orbitaria para la instalación de implantes craneofaciales / Morphometric study of orbital region for craneofacial implant applications

El objetivo de esta investigación es establecer las relaciones morfométricas presentes en las regiones periorbitarias utilizadas para la instalación de implantes craneofaciales. Se diseñó un estudio descriptivo utilizando 40 cráneos humanos de entre 20 y 60 años del Laboratorio de Anatomía del Departamento de Morfología de la Facultad de Odontología de Piracicaba de la Universidad Estadual de Campinas. Fueron realizadas tomografías volumétricas cone beam y a partir de la reconstrucción virtual se precisaron los puntos de análisis, basados en la literatura científica, tanto clínica como anatómica de la región. Se realizaron divisiones de la órbita respetando distancias mínimas y reparos anatómicos como el seno frontal y seno maxilar. En las mediciones realizadas, se observó que el área supraorbitaria presentaba una distancia ósea sagital de 8,14mm +/- 1,91mm, el reborde infraorbitario de 7mm +/- 1,71mm y el área lateral de órbita un promedio de 7,91mm +/- 1,15mm. Considerando que los implantes de mayor dimensión son de 6mm, la instalación de implantes en estas regiones está totalmente asegurada en términos de requerimientos de cantidad ósea regional.

The aim of this research was to study the morphometric relation present in periorbital region, used in the installation of craniofacial implants. A descriptive study was carried out using 40 skulls between 20 and 60 years of age from the Laboratório de Anatomia do Departamento de Morfologia da Facultade de Odontologia de Piracicaba da Universidade Estadual de Campinas. Volumetric tomography with cone beam technique was used along with virtual reconstruction, with the point of analysis being selected based on the clinical and anatomical scientific literature. Orbital division was realized with minimal distance from the frontal and maxillary sinus. During measurement it was observed that the superior orbital rim presented a sagittal bone distance of 8.14mm +/- 1.91 mm; inferior orbital rim of 7mm +/- 1.71 mm, and the lateral orbital presented an average of 7.91 mm +/- 1.15 mm, considering that craniofacial implants present up to 6 mm in length, the installation of implants in this area is considered safe in terms of regional bone quantity requirements.

Transplante facial: una realidad clínica / Facial transplantation: a reality

La desfiguración de la cara es una condición devastadora. El transplante facial ha surgido como una nueva alternativa de tratamiento para pacientes con desfiguración severa. Ocho transplantes faciales se han llevado a cabo desde el año 2005. En este artículo se discuten los aspectos técnicos, inmunológicos y éticos relacionados con el transplante facial.

Facial disfigurement is a devastating condition. Facial transplantation has emerged as a new technique for severely disfigured patients. Eight facial transplants have been performed since 2005. Several aspects of facial transplantation are discussed including immunosuppressive, technical and ethical aspects.