Investigation of Risk Acceptance and Expectations in Facial Allotransplantation

PURPOSE: Facial allotransplantation (FA) could provide an excellent alternative to current treatments for facial disfigurement. However, despite being technically feasible, there continues to be various ethical and psychosocial issues associated with the risks and benefits of performing FA. The purpose of this study is to investigate risk acceptance and expectations in FA. METHODS: In a quantitative assessment of risk versus benefit with respect to FA, from 2004 to 2008, Barker et al. developed and published a questionnaire-based instrument (Louisville Instrument for Transplantation [LIFT]), which contained 237 standardized questions. In the current study, the authors assessed risk versus benefits and expectations of FA using a Korean version of the LIFT. Respondents in three study groups (lay public, n=140; medical students, n=120; doctors, n=34) were questioned about risk acceptance as related to immunosuppression and tissue rejection, and expectations as related to quality of life improvement, and functional and aesthetic outcomes. A summary of the data has been provided and statistical analyses were performed. RESULTS: Among the three study groups, results indicated that doctors accept the least amount of risk for a facial allotransplant, followed by medical students, and finally lay public. There was a significant statistical difference in three of the four questions regarding risk acceptance between the groups (p < 0.05). In general, lay public exhibited higher expectations for facial allotransplantation than the other groups. Additionally, there was a significant statistical difference in the importance of aesthetic outcome between the groups (p < 0.05). CONCLUSION: The authors' data indicate the three populations have vastly different levels of risk acceptance and expectations with regard to FA. Therefore, it is very important that surgeons establish clear, open, and thorough communication with patients in their consultations regarding FA. This is particularly important with respect to whether or not a patient's level of risk acceptance and expectations are progmatic.

Staged Correction of Cicatricial Upper Eyelid Retraction and Contralateral Upper Eyelid Ptosis

Upper eyelid retraction may result in conjunctival and corneal exposure as well as a cosmetic problem. Ptosis can disrupt vision and makes it difficult to carry out everyday activities such as reading or driving. Although various surgical methods for correction of upper eyelid retraction and ptosis have been reported, correction of cicatricial upper eyelid retraction and contralateral ptosis in a patient still remains a challenging problem. We performed a staged procedure with a 6-month interval for correction of cicatricial upper eyelid retraction and contralateral ptosis with satisfactory results. A 21-year-old male patient presented with right upper eyelid retraction due to a previous lacerated wound and left upper eyelid ptosis. At first, levator recession and adhesiolysis via a skin incision were performed to correct the right eyelid retraction. About 6 months later, Muller tucking was done to correct the left eyelid ptosis. Patient's postoperative course was uneventful without any complications. At 1 month follow-up, the patient revealed excellent results from both functional and cosmetic point of view. Therefore, a careful surgical approach is needed for correction of cicatricial upper eyelid retraction and contralateral ptosis.

Clinical Experiences about Correction of Web Space Contracture and Syndactyly using V-M Plasty

PURPOSE: The loss of web space is caused by congenital syndactyly or acquired burn injury, trauma or surgery. Numerous surgical procedures have been described for restoration of the web space. Local flaps are usually preferred because of the easiness to perform and tolerable postoperative outcome. Among the various local flaps, the authors introduce V-M plasty for correction of web space contracture and syndactyly. METHOD: From March 2007 to Jun 2008, 4 patients underwent V-M plasty for correction of web space contracture and syndactyly. V-M plasty consists of 3 distinct triangular flaps. One triangular flap is designed next to the web region on the dorsal site of the hand, whereas the remaining 2 triangular flaps are placed on the volar site. The dorsal triangular flap is then placed between the volar adjacent triangular flaps. At the end of the operation, the involved fingers or toes are positioned in abduction to avoid kinking of the triangular flaps. RESULT: All the patients gained web functions with good esthetic appearance without any recurrence or complications. Mean follow-up was 8 months. CONCLUSION: V-M plasty is a safe, easy and rapid procedure to design and apply by using local tissues without the needs for a skin graft or risk of linear scarring and recurrence. The authors advise this versatile technique both in primary and recurrent cases of web space contracture and syndactyly.