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Contribution to Book
Composite tissue allotransplantation to treat veterans with complex amputation injuries
Shaping the future: military and veteran health research (2011)
  • Vivian C. McAlister
  • Ray Kao
  • Brian Church
  • Markus Besemann
  • Rob Stiegelmar

Amputee rehabilitation may be limited by complexity of injury (e.g. bilateral arm amputation), associated injury (e.g. colostomy) or by the level of amputation (e.g. high above knee). Our objective is to assess the potential for composite tissue allotransplantation (CTA) to overcome these barriers. Medical literature was searched and programs were surveyed regarding the current status of CTA. Results CTA remains an experimental reconstructive option that involves a large collaborative (physiatry, orthopaedic, plastic and transplant surgeons). Limb transplantation has evolved out of limb reimplantation surgery and organ transplantation. Approximately 10 programs world wide, with almost a decade of experience, report 90% success with good function. Most experience in forearm transplantation (50 grafts in 36 patients). Research in London ON, where a civilian CTA program is being developed, has demonstrated the protective effect immunologically of vascularized bone marrow so that the immunosuppressive requirements are equivalent or less than those for organ transplantation. A review of Canadian casualties suggests that relatively few will require forearm transplantation and more would benefit from above-knee leg replacement. Knee transplantation, permitting conversion to a below knee prosthesis, has been as successful as forearm transplantation. Conclusions CTA may offer options for treatment of carefully selected veterans who are motivated to take part in an experimental reconstructive program. Lay Summary: Carefully selected combat casualties with difficult amputations may be good candidates for a limb transplantation program being developed in London ON. Worldwide experience suggests forearm transplantation is very successful with relatively low immunosuppressive drug requirements. Combat casualties will require leg as well as hand transplantation.

  • combat,
  • military medicine,
  • combat injuries,
  • amputation,
  • surgery,
  • limb transplantation,
  • improvised explosive device,
  • blast injury
Publication Date
Aiken AB, Belanger SAH
Canadian Defence Academy Press
Citation Information
Vivian C. McAlister, Ray Kao, Brian Church, Markus Besemann, et al.. "Composite tissue allotransplantation to treat veterans with complex amputation injuries" Kingston (Canada)Shaping the future: military and veteran health research (2011)
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