Composite Tissue Transplantation
One of the latest achievements of reconstructive surgery today is composite tissue transplantation. This includes the transplantation of tissues such as arm and leg transplants, called limb transplants, face and scalp, uterus, muscle, nerve and tendon transplants, from a brain-dead cadaver to a living patient. The main technique in the surgery of these transported tissues is the use of microsurgical applications. Although these surgeries are technically very difficult, they also include some important medical practices that the patient must follow for life in the postoperative period. As a result, the transplanted tissue is foreign to the recipient body and the recipient's immune system fights these tissues to reject it. If this immune system is not suppressed, the body will reject the transplanted organ and cause its loss. For this reason, these patients must take the same immune-suppressing drugs that patients with heart, kidney and liver transplants take. However, these drugs are not innocent at all and can cause serious problems in the future, such as causing cancer and life-threatening opportunistic infections. For this reason, patients should undergo very detailed research before performing surgeries such as facial and extremity transplants, which are not essential for life, such as liver and kidney transplants - which are intended to increase the patient's functions and provide aesthetic gain.
In our country, the Ministry of Health determines where and under what conditions these surgeries are performed. and by whom it will be done, has been determined by instructions. In my opinion, although I think that the selection of patients who will undergo surgery may change in accordance with the requirements of the age, other issues are clear in this directive. Currently, there are four centers in our country, including Hacettepe University, licensed by the Ministry of Health to perform these surgeries. And in these centers, there are Plastic Surgeons, including me, whose ability to perform these surgeries has been approved by the Ministry of Health. If I tell you about the procedure, first the patient applies to the Composite Tissue Transplantation Center of the licensed university for limb or face transplantation. Here, it is first pre-screened and complies with the indication list issued in accordance with the Ministry of Health Composite Tissue Transplantation Regulation, the link of which I have given below. It is evaluated that it does not comply. Then, the patient is evaluated before the surgery by the necessary psychiatric, internal medicine, nephrology, anesthesia, ophthalmology, ear, nose and throat, orthopaedics, neurology and a few consultant physicians to be added depending on the patient, whether he has a mental and physical health suitable for this major surgery. After these consultations are completed, the patient is referred to the Composite Tissue Transplantation Council, whose qualification has been approved by the Ministry of Health and which will allow whether these surgeries can be performed or not. If it is decided that the patient is a candidate for these surgeries, all identity and health information of the patient is reported to the Ministry of Health Organ and Tissue Transplantation Center. When a tissue donor becomes available, this center notifies the university composite tissue center and if this center accepts, the surgical and medical process begins. After the surgeries are completed, the details and results of the surgery are sent to the Ministry of Health in the late period to ensure that this initiative is inspected.
At our university hospital, under my chairmanship, it is the 3rd full face transplant in the world, the 2nd in Turkey and the 22nd in the world among all partial and full face transplants. We performed the face transplant. We were able to provide mimic muscle movements in this patient very early with postoperative early physiotherapy methods. Because, in addition to functional gain, the most desired aesthetic result in face transplants is to obtain the highest level of results. The most common problem in face transplants performed so far is that the patient is provided with a motionless face in the form of a mask face, since the patient's facial muscles cannot work. This may depend on the severity of the patient's trauma or may be related to the surgical technique. In our opinion, the functional result related to the functioning of the facial muscles achieved by the face transplant we have performed is a result that can be rarely detected in the world.
The world's first double arm and leg transplant was performed with our face transplant patient under my chairmanship. Although we were surgically successful in this surgery, our patient developed some serious medical problems and we lost our patient on the 4th day after the surgery. However, this surgery took its place in the medical literature as the world's first simultaneous arm and leg transplant.
It can be understood from the result that made us very sad in our last patient. These are interventions that involve the risk of death, especially serious surgery such as limb transplants, heart surgery, etc. For this reason, patients are asked to sign not only the consent form required by the Ministry of Health, but also the consent forms prepared by Hacettepe University Composite Tissue Transplantation Center, and in these forms, an extensive document is read and explained, including all the risks the patient faces during and after the surgery, including death, and the side effects of the medications he will take for life if the surgery is successful. and signed in front of witnesses. However, although very sad and undesirable results are observed from time to time as a result of these surgeries, both in the world and in Turkey, there is a very important fact. It causes our veterans to lose their limbs as a result of work or traffic accidents like ours, or as a result of terrorist attacks in our country that upset us very much, or to scars and scars on their faces that will create social phobia when going out in public. These composite tissue transplants, which we will be able to perform with our advanced level of medicine and surgery, will be one of the great aids we will offer to these patients and veterans and will enable them to return to normal life. In this way, I think we can repay our debt of gratitude to some extent to our veterans who need these surgeries.
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