One of the latest points of reconstructive surgery today is composite tissue transplantation. This includes the transfer of tissues such as limb transplants, arm and leg transplants, face and scalp, uterus, muscle, nerve and tendon transplants from a cadaver to a living patient. The main technique in the surgery of these transported tissues is the use of microsurgical applications. These surgeries are technically very difficult operations, as well as some important medical applications that must be followed for a lifetime for the patient in the postoperative period. As a result, the transplanted tissue is foreign to the recipient body, and the recipient’s immune system fights them to reject it. If this immune system is not suppressed, the body rejects this transplanted organ and causes its loss. For this reason, this patients have to take the drugs that supress the immune system and this drugs are similar using of recipients of heart, kidney transplantation and liver transplant. However, these drugs are not innocent at all and can cause serious problems in the future, such as cancer and potentially life-threatening infections. For this reason, surgeries such as liver and kidney, which are not essential for life, such as face, extremity transplantation, which are to increase the patient’s functions and provide aesthetic gain, patients should undergo a very detailed investigation before being applied.
In our country, the Ministry of Health has determined in which conditions, where and by whom these surgeries will be performed. In my opinion, although I think that the selection of patients to be operated on may change according to the requirements of the, 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 operations. And in these centers, there are Plastic Surgeons, 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 licensed University’s Composite Tissue Transplantation Center for limb or face transplantation. Here, it is first pre-screened and it is evaluated whether it complies with the indication list issued in accordance with the Ministry of Health Composite Tissue Transplantation Regulation, which I have given below. Then, the patient is evaluated by the psychiatric, internal, nephrology, anesthesia, eye, ear, nose and throat, orthopedics, neurology and a few consultant physicians who will be added according to the patient, whether there is a suitable mental and body health before the surgery. After these consultations are completed, the patient is admitted to the Composite Tissue Transplantation Council, which has been approved by the Ministry of Health and will allow these surgeries to be performed or not. If the patient decides that he / she 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 emerges, it is notified to the university composite tissue center by this center and if this center accepts, the surgical and medical process begins. After the operations are over, the details and results of the surgery are sent to the Ministry of Health in the late period and this initiative is monitored.
Face Transplant Operations
Our university hospital had the world’s 3rd full face transplant in my presidency, Turkey’s 2nd and 22nd in the world in all partial and full-face transplants have performed the face transplant. With the early post-operative physiotherapy methods we performed, we provided mimic muscle movements in this patient in the very early period. Because facial transplants are to get the highest level of results as the most desired aesthetic result besides functional gain. The most common problem encountered in facial transplants so far is the patient’s ability to provide an immobile face in the form of a mask face, since the patient cannot operate his mimic muscles. This situation may be related to the severity of the patient’s trauma as well as to the surgical technique. According to our opinion, the functional result related to the functioning of the mimic muscles reached by the facial transplant we performed is a rare result in the world. Together with our face transplant patient, the world’s first double arm and leg transplant was performed under my leadership. Although we were surgically successful in this surgery, we lost our patient on the 4th postoperative day with some serious medical problems that developed in our patient. However, this surgery took its place in the medical literature as the world’s first arm and leg transplant performed simultaneously.
As can be understood from the result that saddened us very much in our last patient, especially limb transplants, a heart surgery etc. They are interventions that include the risk of death, such as a serious surgery. For this reason, patients are asked to sign both the consent form requested by the Ministry of Health, as well as the consent forms prepared by the Hacettepe University Composite Tissue Transplantation Center, and among these forms, all risks including the death of the patient during and after the surgery, and the side effects of the drugs that will be taken for life if the surgery is successful. a document is read, explained and signed before witnesses. As a result of work or traffic accidents or terrorist attacks that upset us in our country, our veterans also cause loss of their limbs or scars and scars on their faces that will cause social phobia when going into society. These composite tissue transplants, which we will achieve with our advanced medical and surgical level, will be one of the great help we will offer to these patients and veterans, and will enable them to return to normal life. In this way, I think we can pay a little bit of gratitude to our veterans who need these surgeries.
Prof. Dr. Serdar Nasır, made Turkey’s 2nd face transplantion Faculty of Medicine at Hacettepe University in 2012. Dr. Nasır was applied frs four extremity transplantation in the world as head of microsurgical team at sometime with face transplantation.
Serdar Nasır ve Cengiz Gül, Kanal A Ekranlarında
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