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Living related hemi-face skin transplant using radial forearm free flap for a xeroderma pigmentosa patient: early outcome.

Amin A, Bassiouny M, Sallam K, Ghally G, El-Karaksy H, El-Haddad A - Head Neck Oncol (2010)

Bottom Line: In addition the girl did not develop skin lesions in the operated site.Our early cosmetic result was very promising.In addition to this, the girl did not develop skin lesions in the operated side of the face.

View Article: PubMed Central - HTML - PubMed

Affiliation: Surgical Oncology Department, National Cancer Instituite, Cairo, Egypt. aymanamin@hotmail.com

ABSTRACT

Introduction: Xeroderma pigmentosa (XP) is a hereditary disease characterized by deficient repair of DNA damage that occurred on exposure of the skin to ultraviolet irradiation. The affected children have a propensity to develop multiple skin cancers mainly in the face and eventually die before the age of 20.

Hypothesis: Allograft replacement of facial skin by a healthy skin from normal person might decrease the incidence of skin cancer development, the number of surgical procedures, and eventually might improve the survival of these miserable patients.

Methods: As Cadaveric organs are unavailable in our country. After approval from the ethical committee, confirmed agreement of the donor and the patient's guardian, a radial forearm free flap was transplanted from an ABO compatible mother to her 5 year old daughter with XP. The mother had an older daughter died from the same disease at the age of 14. The flap replaced skin of the hemi face that developed precancerous lesions. The girl was kept on adjusted doses of immunosuppressive drugs.

Results: The flap survived, wounds healed uneventfully. The flap developed a reddish spot one and half month following transplant where baseline skin biopsy was taken. In the fifth months the girl presented with bad non salvageable rejection that ended up loosing the flap. On long term follow up, the girl started to develop skin lesion on the virgin half of the face. Our early cosmetic result replacing half of the facial skin was very promising. In addition the girl did not develop skin lesions in the operated site.

Conclusion: Our early cosmetic result was very promising. In addition to this, the girl did not develop skin lesions in the operated side of the face.

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Ten months post transplant where the patient started to develop skin lesions in the contra lateral side (marked by an arrow). Worth noting that the side operated upon and left to heal by secondary intention did not develop any new lesions.
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Figure 11: Ten months post transplant where the patient started to develop skin lesions in the contra lateral side (marked by an arrow). Worth noting that the side operated upon and left to heal by secondary intention did not develop any new lesions.

Mentions: Two months post transplant: The girl was doing fine, apart from hirsutism form the cyclosporine. The girl has missed the follow up for 3 weeks before this visit and presented, in the fifth month, with clinical evidence of graft rejection. The trough level of Cyclosporine at presentation was below the target level. Interestingly enough, the skin graft was not affected with the rejection process. A trial of salvaging the flap by corticosteroids and manipulating the immunosuppressants was unsuccessful, so the flap was removed, immunosuppressants were discontinued and the face was left to granulate (Figures 7, 8, 9, 10). For obvious reasons, the third stage of the planned procedure (tissue expansion) was aborted. By the 10th month Postoperative, the patient started to develop malignant lesions in the non-operated side of her face (Figure 11). The donor site in the mother that was closed by a partial thickness skin graft healed uneventfully as well (Figure 12).


Living related hemi-face skin transplant using radial forearm free flap for a xeroderma pigmentosa patient: early outcome.

Amin A, Bassiouny M, Sallam K, Ghally G, El-Karaksy H, El-Haddad A - Head Neck Oncol (2010)

Ten months post transplant where the patient started to develop skin lesions in the contra lateral side (marked by an arrow). Worth noting that the side operated upon and left to heal by secondary intention did not develop any new lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908605&req=5

Figure 11: Ten months post transplant where the patient started to develop skin lesions in the contra lateral side (marked by an arrow). Worth noting that the side operated upon and left to heal by secondary intention did not develop any new lesions.
Mentions: Two months post transplant: The girl was doing fine, apart from hirsutism form the cyclosporine. The girl has missed the follow up for 3 weeks before this visit and presented, in the fifth month, with clinical evidence of graft rejection. The trough level of Cyclosporine at presentation was below the target level. Interestingly enough, the skin graft was not affected with the rejection process. A trial of salvaging the flap by corticosteroids and manipulating the immunosuppressants was unsuccessful, so the flap was removed, immunosuppressants were discontinued and the face was left to granulate (Figures 7, 8, 9, 10). For obvious reasons, the third stage of the planned procedure (tissue expansion) was aborted. By the 10th month Postoperative, the patient started to develop malignant lesions in the non-operated side of her face (Figure 11). The donor site in the mother that was closed by a partial thickness skin graft healed uneventfully as well (Figure 12).

Bottom Line: In addition the girl did not develop skin lesions in the operated site.Our early cosmetic result was very promising.In addition to this, the girl did not develop skin lesions in the operated side of the face.

View Article: PubMed Central - HTML - PubMed

Affiliation: Surgical Oncology Department, National Cancer Instituite, Cairo, Egypt. aymanamin@hotmail.com

ABSTRACT

Introduction: Xeroderma pigmentosa (XP) is a hereditary disease characterized by deficient repair of DNA damage that occurred on exposure of the skin to ultraviolet irradiation. The affected children have a propensity to develop multiple skin cancers mainly in the face and eventually die before the age of 20.

Hypothesis: Allograft replacement of facial skin by a healthy skin from normal person might decrease the incidence of skin cancer development, the number of surgical procedures, and eventually might improve the survival of these miserable patients.

Methods: As Cadaveric organs are unavailable in our country. After approval from the ethical committee, confirmed agreement of the donor and the patient's guardian, a radial forearm free flap was transplanted from an ABO compatible mother to her 5 year old daughter with XP. The mother had an older daughter died from the same disease at the age of 14. The flap replaced skin of the hemi face that developed precancerous lesions. The girl was kept on adjusted doses of immunosuppressive drugs.

Results: The flap survived, wounds healed uneventfully. The flap developed a reddish spot one and half month following transplant where baseline skin biopsy was taken. In the fifth months the girl presented with bad non salvageable rejection that ended up loosing the flap. On long term follow up, the girl started to develop skin lesion on the virgin half of the face. Our early cosmetic result replacing half of the facial skin was very promising. In addition the girl did not develop skin lesions in the operated site.

Conclusion: Our early cosmetic result was very promising. In addition to this, the girl did not develop skin lesions in the operated side of the face.

Show MeSH
Related in: MedlinePlus