Skin Transplant: a Reconstructive Surgery
Skin Transplant: Risk factors, Diagnosis, and Treatment
Skin transplant or skin graft is a type of graft surgery that involves the transplant of skin and the tissues that are transplanted are called skin graft. The skin graft is usually done in cases of severe injury when body tissues are injured. Skin transplant is often used in the following conditions:
- In burn injury.
- After severe trauma of the injury.
- Excessive skin loss due to infection like purpura-fulminant or necrotizing fasciitis.
- In certain surgeries, skin graft is required, such as in cases of removal of skin cancer surgery.
Skin graft not only have cosmetic importance by enhancing the look of the patient but also helps to fasten the process of healing, thereby, reducing the course of treatment.
Types of skin grafts:
There are three main types of skin graft:
- Split thickness graft: It is the most common type of skin graft. In this type of graft, the epidermis or the topmost layer of the skin is removed along with a little part of the dermis.
- Full-thickness graft: This type of graft is usually recommended for face surgery. The epidermis, dermis and the hypodermic are transplanted.
- Composite skin graft: This type of graft is used for three-dimensional reconstruction such as the nose. This type of transplant involves grafting of skin, muscles fats and cartilage.
Risk and complications of skin transplant:
The potential risk of skin graft are:
- Bleeding
- Hematoma
- Infections
- Scarring of the skin
- Irregularity of skin texture
- Death of skin graft
- Loss of sensation
- Hypersensitivity of skin
Pre-graft procedure:
The wound that needs a graft is first cleaned and is then measured to ensure the number of cells needed for transplant.
Anesthesia is administered, the anesthesia can be either local or general depending on the age, location of injury and nature of the injury.
What to expect during the procedure?
The harvested donor skin is removed by a scalpel or “dermatome” which is a special device used to harvest the skin. The donor skin sometimes harvested using the of “messing”; which is involves making several small controlled incision placed in the graft allowing fluid to leak from the underlying tissue of the donor skin cells to spread over a large area. After extraction of the skin cells, the site is closed in case of full-thickness graft or composite graft sutures are also required to close the wound.
The graft is then transplanted to the recipient. The graft is placed at the correct site and is then sutured to the neighboring tissues. A pressure bandage is then applied at the site of skin transplant along with a vacuum device called wound VAC which controls drainage this increases the chances of graft survival.
Initially, the graft gets its nutrition from the neighboring cells but once when healing process sets in the graft forms new blood vessels, followed by the growth of new cells. Thus, covering the area with new skin cells.
Post-operative care:
Both living donors and recipient must take care that the wound is kept moist and well protected.
Kidney Transplant or Renal Transplant
Kidney Transplant: Risk factors, Diagnosis, and Treatment
Kidneys are a pair of bean-shaped organs situated on the posterior part of the abdominal cavity. The kidneys regulate water and electrolyte balance in the blood. The waste is excreted out as urine after the filtration of blood in the kidney. Kidney transplant or renal transplant is a procedure that is performed at end-stage kidney disease. The kidney is donated either by a living donor who may or may not be genetically related or from a dead donor.
Indications for a kidney transplant:
Kidney transplant is indicated in cases of end kidney diseases irrespective of the primary cause of the kidney damage. The common causes that result in end-stage kidney disease are:
- Diabetes
- Uncontrolled high blood pressure.
- Polycystic kidney disease
- Chronic glomerulonephritis.
- Autoimmune diseases such as lupus.
- Congenital metabolic errors
Kidney transplant is contraindicated for the following people:
- Having heart disease or lung diseases.
- Obese people
- Who smoke tobacco
- In liver disorder
- Cancer Patients
- Taking psychotropic drugs or are indulged in substance abuse.
Pre-operative procedure:
Before the kidney is transplanted, the compatibility of the donor’s kidney must be matched with the recipient’s kidney. Following parameters are generally checked:
- Blood typing- the recipient must have a compatible blood group with the donor. Blood type incompatible kidney transplant is possible but it requires extra medication to reduce the risk of organ rejection.
- Tissue typing– once the organs are blood compatible the human leukocyte antigen, is checked. If these factors match it reduces the chances of organ rejection.
- Crossmatch- this step is the last and final step in which the blood of the donor and the recipient is mixed in the lab to see if they are compatible or not. A negative crossmatch indicates that the kidney is compatible with the recipient, a positive crossmatch indicates that the kidney transplant can be performed but extra medication must be given so that the recipient does not reject the transplanted kidney.
Procedures:
Anesthesia is administered to the patient. Then an incision is made on the lower part of the back. The new kidney is transplanted near the iliac fossa and the blood vessels are connected to the blood vessels of the new kidney is attached to the lower part of the abdomen. The blood vessels that supply blood to the lower extremities. The old kidneys are removed only if the kidney is causing problems like hypertension, kidney stones, infection, and pain. The new kidney’s ureter is connected to the urinary bladder.
Post-operative care:
After the surgery, the patient is shifted to the ICU where they are kept for 2-3 days. Then they are shifted to the transplant recovery area where the patient is monitored for the next 4-5 days. Once the patient is discharged he is advised:
- Visit the doctor often for Post-operative follow-ups.
- Take medicines regularly.
- Consult a dietician for a balanced diet post-surgery.
- Avoid grapefruit
- Consume healthy protein
- Exercise regularly
Cornea Transplant: A Gift of Sight
Cornea Transplant: Risk factors, and Types
The cornea is the transparent anterior portion of the eyes. The clear dome-shaped layer that covers the anterior or front part of the eyes. It helps to focus on the vision. In Cornea transplant or corneal graft; the tissue or graft is taken from a recently died donor who had no disease or any other factors that can cause damage to the grafted tissue (of the recipient). An ophthalmologist performs corneal transplant surgery.
Types of cornea transplant:
- Penetrating keratoplasty, in this type of transplant the whole cornea is replaced.
- Lamellar keratoplasty, in this type of transplant the inner end of the cornea is transplanted.
Keratoplasty means corneal transplant.
Indications/conditions where cornea transplant is needed:
- To improve the visual acuity of the recipient by replacing the opaque or distorted cornea by a healthy cornea of the donor.
- To reconstruct the anatomy of the eyes.
- To remove inflamed corneal tissue which is not responding to any medicines.
- For cosmetic purposes.
Risk of corneal transplant:
It is a very safe procedure. The complications associated with this procedure is very rare, however, if present these are the following serious complications:
- Eye infection
- Glaucoma or increase in intraocular pressure
- Increased risk of cataract
- Rejection of the donated cornea
- Swelling of the cornea
Signs of rejection of cornea transplant:
- Loss of vision
- Pain in eyes
- Redness of eyes very often
- Sensitive to light
How to prepare for the surgery:
Before surgery the doctor accesses the patient and examines the following :
- A thorough examination of eyes is done to reduce complications after a cornea transplant.
- Determine the size of how much donor cornea cells will be required for the transplant.
- To treat ailments of the eyes which can cause inflammation or infection in the eyes after the surgery.
During the transplant:
Anaesthesia is administered to the patient, the anaesthesia can either be local or General depending on many factors like age, health, eye injury, or disease of the patient
In penetrating keratoplasty, which is the most common type cornea transplant the doctor cut through the entire corneal thickening and remove a small button-sized corneal disc and replace it by the healthy donor cornea cells.
In Lamellar keratoplasty, the anterior or the endothelial cells of the diseased cornea is removed and replaced by the healthy donor cornea cells.
The patient in whom the surgery was conducted on local anaesthesia and was awake during the procedure did not complain of any discomfort during the procedure.
Post-surgery care:
- After the surgery, the patient is advised to use certain eye drops and rarely some oral medicines are also given to prevent any infection and to fasten the process of healing also.
- Wearing a patch helps to heal the eyes after surgery as it prevents exposure to very bright light.
- Visit the doctor often for Post-operative follow-ups.
Heart Transplant: a hope for people with terminal Heart Ailments
Heart Transplant: Procedure and Complications
Heart Transplant or Cardiac Transplant is a surgical procedure in which a diseased heart (of a recipient) gets transplanted for a healthy heart (from a donor). The heart donor is someone who had died (brain-dead). Cardiac transplant is indicated in cases of the terminal illness of the heart when all other surgical and medical interventions have failed to give the desired results.
The first successful heart transplant was in 1967. Heart transplant has become very common in 2019 with around 3,500 heart transplants.
Contra-indication for Cardiac Transplant:
A Heart Transplant or Cardiac Transplant is not indicated for persons with:
- Terminal or advanced stage of kidney, lungs or liver disease.
- Having cancer.
- A person having life-threatening diseases, unrelated to heart either systemic disorders or acute infections.
- People having a disorder of the blood vessels, especially of neck and legs arteries.
- People with pulmonary hypertension.
- For people with uncontrolled diabetes with severe dependency on insulin.
- Highly obese people.
- People with a history of strokes and blood clots.
- Old adults especially people who are above sixty-five years old.
- People who consume too much alcohol and smoke tobacco.
Procedures followed just before the surgery
As soon a heart donor is found, the recipient is called to the hospital as soon as possible. The donor’s heart is removed first, as the heart muscle starts to die within 4-5 hours after the extraction. The recipient is then checked for the compatibility with the donor’s heart. If the donor’s heart is compatible with the recipient’s heart then the doctors go ahead with the surgery.
During the procedure:
- A heart transplant is a time-consuming and complex surgery.
- The patient is first sedated and then the doctors connect a heart-lung machine to the patient.
- The surgeon then opens up the rib cage exposing the diseased heart.
- Sometimes the diseased heart is left in the recipient body or sometimes removed.
- The donor’s heart is then placed in the place of the diseased heart.
- All major blood vessels are connected to the donor’s heart.
- Sometimes the donor’s heart needs some electric shock to work properly.
- The incision is then closed and sutured.
Post-operative care:
- administer Pain-killers to reduce pain.
- The patient is kept on a ventilator for a few days in the ICU.
- Monitor the patient for any signs and symptoms for rejection of organs such as fever, edema, less urination, weight gain.
- Follow-up with the doctor often and get the blood test, ECG and heart biopsy done as advised by the doctor.
Complications:
- Infections
- Bleeding
- Blood clots
- Heart attack
- Stroke
- Death
Lifestyle changes after surgery:
- Take medicines regularly as advised by the doctor.
- Avoid crowded places as you are on immunosuppressant/s that make you more likely to develop an infection.
- Keep weight in check.
- Take care of your blood sugar and blood pressure levels within normal limits.
- Do not smoke tobacco
- Exercise regularly
- Avoid alcohol consumption
A surgical overview of Lung Transplant
Lung Transplant: Types: Contraindications, Procedure
Do you know that the first human lung was transplanted in 1963? Even the first successful heart-lung surgery was performed in 1981. So what is this lung transplant?
Lung transplantation or Pulmonary transplantation is a surgical procedure where the diseased lung gets transplanted with a healthy lung or lungs or with only a lobe. A single lobe of the lung is usually transplanted from an alive donor. There are a few complications of a lung transplant. If the transplant is successful then the life expectancy of the recipient increases.
Types of lung transplant:
- In Lobe transplant, a single lobe of the lung is usually transplanted. An alive donor can give only one lobe. If more than one lobe is needed, then the lungs are retrieved from more than one donor. If the lobes are procured from the deceased donor then both the lobes are extracted. The live donors are screened properly to make sure that they lead a quality life, even after the reduction of a lobe.
- Single lung transplant is a single lung transplantation surgery.
- Both lung transplant is a surgery where both the diseased lungs of the recipient are replaced by the healthy lungs of the donor.
- In cases of severe respiratory distress, the heart also gets affected. In such cases, the heart-lung transplant is often suggested.
Contra-indication for surgery:
- Chronic ailments of heart, lungs, kidneys or liver
- Infections such as HIV or hepatitis
- Recent history of cancer or people having cancer.
- People who consume alcohol, smoke tobacco or other harmful drugs.
- Older adults especially people who are more than 65 years.
- People who do not follow the instructions of the doctor.
Pre-operative care:
Transplantation of lungs is usually a very long and complicated method. Once a potential donor is found in cases of an alive donor, he/she is evaluated properly. Besides, the recipient is also evaluated. If doner-recipient evaluation suggests the transplant is possible; then the doctor goes ahead with the process.
During the procedure:
After sedating the patient. Connect the patient with the heart-lung machine. An incision is made in the diseased lung/lungs/lobes or heart and lungs and replaced by healthy donor organs.
The major blood vessels connected to the diseased lungs are then connected to the new lungs. The incision is later sutured together.
Post-operative care:
Move the patient to the ICU for three to four days after surgery. Immunosupperent and Pain-killers are administered to the patients to subside the pain. This also decreases the chances of rejection of the donated organs also.
- Visit the doctor often
- Go for the blood test, and biopsy as advised by the doctor to see if there are any infections or any signs of rejection or cancer in the organ
- Take medicines as advised by the doctor
- Exercise regularly as advised by the physiotherapist
- Avoid alcohol, tobacco or any harmful drugs
Complications of the surgery:
- Fever
- Flu-like symptoms
- Difficulty in breathing
- Pain in chest
- Loss of weight
Transplantation of the Diseased Liver
Transplantation of the Diseased Liver
Do you know which is the second-largest organ of the body? It is the liver (after the skin) and weighs around 1.5kgs. If the liver is damaged permanently and is unable to perform its function then the damaged liver is transplanted with a healthy liver. The surgical procedure of replacing the diseased liver with a healthy liver is called liver transplant.
The procedure is a very complicated and time-consuming surgery and usually, orthotopic transplant is preferred. In this type of transplant, the diseased liver is removed and is replaced by a healthy liver at the same anatomical site. The transplant is done by highly trained transplant doctors.
Contra-indication:
- For people with high blood cholesterol levels
- Substance abuse/alcohol abuse
- For people with an advanced stage of liver cancer
- Chronic ailments of the heart and lungs
- People with HIV infections
- People with hyperglycemia and hyperextension.
- Obese people
Types of donor:
- The living liver donor: only a part of the liver is donated. Usually used in pediatric cases.
- Domino liver transplant: in which a healthy liver of the donor is transplanted by the diseased liver. This type of transplant is usually done in people suffering from Amyloidosis. It usually takes 10- 12 years to develop symptoms of Amyloidosis. This type of liver transplant is done in cases where the donor is aged 60 years or more.
- Dead liver donor: in this type, the liver of a dead person is taken and is then transplanted in another person who has a diseased liver. The whole liver is removed from the donor and is transplanted in the recipient.
Preoperative care:
Before the procedure the recipient is asked to take care of the following:
- Maintain a healthy lifestyle
- Keep blood pressure and blood sugar levels in control
- Keep blood cholesterol levels in control
- Taking medicines as advised by the doctor
- Exercise regularly
- Avoid substance abuse
- Follow a healthy diet, as advised by the dietician.
During the procedure:
This surgical procedure is done under the effects of anesthesia. An incision is made and the liver is exposed.
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- In the case of a deceased donor liver transplant, the whole liver is transplanted and the diseased liver is removed. The transplanted healthy organ is then connected to all the major blood vessels and bile ducts.
- In the case of a living donor liver transplant, a part of the liver is removed from the donor and is transplanted in the recipient’s body. The major blood vessels and bile ducts are connected. The donor’s liver regenerates the part of the donated organ, within a few months.
Post-operative care:
- The patient is moved to the ICU for 4-5 days after the surgery.
- Take medicines regularly
- Visit the doctor often
- Eat healthy food
- Exercise regularly
- Take low fat or without fat dairy products.
- Eat fiber-rich food
Complications:
- Rejection of the graft either acute or chronic
- Bleeding
- Complications of bile duct
Pancreas Transplant: surgery for Diabetic People
Pancreas Transplant: surgery for Diabetic People
The pancreas is a compound acinotubular gland located behind the stomach. The pancreas is both an exocrine and an endocrine organ. The exocrine part of the pancreas helps in the digestion of food, whereas, the endocrine part of the pancreas functions to regulate blood sugar levels. In cases when the pancreas does not function completely then the doctors advise transplant of the pancreas.
A pancreas transplant is done in cases of diabetes when the pancreas is not able to synthesize the required amount of insulin and rarely in a certain type of cancer. A pancreas transplant is the last retort and should be done only when no other option is left.
Types of pancreas transplant
The donors of the pancreas are usually brain dead people
- Transplant of a pancreas alone,
- Transplant of pancreas and kidneys especially in cases of diabetes nephropathy, in such type of pancreas transplant kidneys, are also transplanted as due to high blood sugar levels the kidneys also losses their ability to perform its function. This type of transplant is also known as a simultaneous pancreas-kidney transplant.
- Transplant of a part of the pancreas. The donor of this type of pancreas transplant is usually biologically close relatives or identical twins.
Examination before transplant
Before transplanting the pancreas the recipient undergoes the following medical examination:
- A blood HIV test.
- Chest X-ray
- Kidney function test
- Echocardiogram or sometimes electrocardiogram or sometimes both.
Contra-indication for pancreas transplant
- History of cancer within the last two years.
- History of heart disease.
- People having coronary disease
- Mal-nourished people.
- People who do not follow doctors advise
- People who are indulged in substance abuse.
Pre-operative care
- Eat healthy and keep yourself healthy
- Exercise regularly
- Take medicines as advised by the doctor
- Do not stress yourself
- Do not smoke tobacco or other harmful drugs.
During the procedure
Anesthesia is administered to the patient. When the patient is under the effect of anesthesia the surgeon makes an incision down the center of the stomach. The surgeon then places the healthy pancreas without removing the diseased pancreas as it helps indigestion. The pancreas is then attached to all major blood vessels.
In cases where the kidneys are also transplanted the kidneys are placed at the site of the kidneys and is connected to the major blood vessels and bladder.
Post-operative care
- After the surgery, the patient is shifted to the ICU for a couple of days.
- Once the patient is stable he is moved to the transplant recovery area where he is kept under observation for a few days.
- After the patient is discharged they are advised to meet the doctors frequently to ensure that there are no complications associated with the transplant.
- Take medicines regularly.
- Eat healthy food
- Exercise regularly
- Have frequent check-ups.
Complications
- Infections
- Bleeding
- Blood clot or thrombosis
- Rejection of the donated organs by the body
- High blood sugar levels.
Complications caused by medicines
- High blood pressure and cholesterol levels.
- Osteoporosis
- Hair loss, sometimes excessive hair growth.
- Weight gain
Organ Transplant: A Boon in Irreversible Organ Failure
Organ Transplant: A Boon in Irreversible Organ Failure
An organ transplant is a surgical procedure in which a healthy organ is surgically removed from a healthy donor and is surgically implanted in the recipient, who has either a damaged organ or the organ is absent. It is a miracle for people suffering from terminal and irreversible organ failure.
The organ recipient is either in the same place as the donor or the organ sent from the donor’s site to the recipient.
- If the donor and recipient of an organ or tissue is the same person, it is an autograft.
- If the organ transplant involves two persons of the same species either alive or dead is an allograft.
- When organ or tissue transplant involves two different species then it is known as xenograft or xenotransplantation.
- When the person who receives an organ, becomes the donor of the same organ for some other recipient, then it is known as dominos transplantation.
In ABO transplantation, organs from incompatible donors are surgically transplanted in the recipient. The recipient is usually a baby who does not have a well-developed immune system.
Organs and tissues capable of transplantation are:
- Heart transplant (dead donor) who was brain-dead and had a healthy heart.
- Heart valve transplant (dead/living/xenograft)
- Heart-lung transplant (dead/dominos transplant)
- Lung transplant from a recently dead donor.
- Kidney (dead/living donors)
- Liver (dead/ living donors) with a healthy liver graft.
- Pancreas (only dead donors)
- Islets of Langerhans (dead/living donors)
- Intestine (dead/ living donors)
- Stomach (dead donor)
- Cornea (dead donor)
- Skin (autograft) to promote healing.
- Bone marrow (autograft/ living donors)
- Blood vessels (autograft/ living donors)
- Testis (dead/ living donors)
Organs for transplantation need to be retrieved within ten hours after the heart has stopped working in dead donors.
Complications after Organ Transplant
Following compilations arise after organ transplant because of immunosuppressant intake. This prevents the immune system to fight against:
- Diabetes
- High cholesterol level
- Increased risk of developing heart disease
- Gastroenteritis
- Anxiety
- Depression
- Gout
- Decreased sexual drive
- Unwanted hair growth
- Increased risk of catching an infection
- Nausea
- Fatigue
- Headache
- Anemia
- Puffy face
- Arthritis
- Ravenous appetite
- Weaken bone
- Rashes and acne
- Mood swings
- Tingling in hand and feet
- Weight gain
- Tremors
- Swelling in hand and weight
Lifestyle changes after Organ Transplant: Tips to lead a healthy life
- Maintain a healthy weight
- Eat healthy food
- Take your medicines regularly
- Visit a doctor if you find new symptoms after an organ transplant.
- Do inform the doctor that you have undergone an organ transplant operation recently.
- Exercise regularly as advised by your doctor
- Control your blood sugar and blood pressure
- Reduce the stress level in your life
- Eat protein-rich food
- Drink plenty of water and fluid
- Avoid high sodium-rich food
- Avoid fatty and oily food
- Get enough rest and sleep
- Monitor your body temperature regularly.
- Avoid weight gain
- Prevent crowded places to avoid infection
- Keep yourself happy and positive
Organ Transplantation Hospitals in India
- Aditya Birla Memorial Hospital , Baner Road, Pune
- B J Medical College and Sassoon Hospital, Pune
- Aditya Birla Memorial Hospital , Baner Road, Pune
- Breech Candy, Mumbai Maharashtra India
- Bhatia Hospital, Mumbai Maharashtra
- Bombay Hospital and Medical Research Centre
- Ruby Hall Clinic, Wanowrie,Pune
- D. Hinduja Hospital, Mumbai India
- Kokilaben Dhirubhai Ambani Hospital, Mumbai
- Jupiter Hospital, Thane Mumbai
- Fortis Hospital, Mumbai,Maharashtra, India
- Asian Heart Institute and Research Centre, Mumbai
- Indraprastha Apollo Hospitals, New Delhi
- VGM Hospital , Singanallur Coimbatore Best multi-specialty accredited hospitals from Coimbatore
- Medanta Hospital, Gurgaon, India
