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Utility of sentinel flaps in assessing facial allograft rejection.

Plast Reconstr Surg. 2014 Sep 24;

Authors: Kueckelhaus M, Fischer S, Lian CG, Bueno EM, Marty FM, Tullius SG, Pribaz JJ, Murphy GF, Pomahac B

Abstract
BACKGROUND:: Skin biopsies are critical for histological evaluation of rejection and proper treatment after facial allotransplantation (FAT). Many facial allografts provide only limited skin area and frequent biopsies may additionally compromise aesthetic outcome. Sentinel flaps (SFs), recovered as free fasciocutanous radial forearm flaps, have been employed for remote site rejection monitoring. They maintain their axial blood supply similar to facial allografts. The correlation between FAT and SF in cases of rejection is presented.
METHODS:: We analyzed the experience of the Boston team's employment of 4 SFs. Rejection was evaluated and the results compared for each time point. The SFs where used as functional flap whenever possible.
RESULTS:: The results show a reliable correlation between biopsies taken from the facial allograft (FA) and SF. During severe rejection episodes in 100% of the biopsy pairs both sites displayed a similar grade of rejection. In one case the clinical findings suggested rejection in the FA but were unraveled as Rosacea, since clinically there was no rejection displayed in the SF.
CONCLUSIONS:: The SF shows a reliable correlation to the FA in cases of severe rejection and therefore provides a valuable tool for rejection monitoring in FAT. Advantages of SF employment include the avoidance of further surgical procedures to the primary VCA, additional utilization of the SF to repair damaged non-facial sites, and its utility as both a clinical and histopathological barometer of rejection and predictor of the potential existence of facial dermatitis unrelated to rejection.Level of evidence: III.

PMID: 25255116 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25255116?dopt=Abstract = URL to article