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Facial nerve paralysis is a debilitating condition with multiple etiologies, with aesthetic, functional, psychological and social impact. Given the complex multitude of causes that may generate such condition, a therapeutic algorithm is mandatory when attempting reconstruction. Severity, timing, patient adherence to a rehabilitation program, status of ipsilateral and contralateral facial nerves and particularities of each patient are all criteria which should be accounted when choosing a treatment option. After initial assessment, a variable treatment panel is available based on condition type include medicamentous therapy, rehabilitation program, dynamic and static procedures surgical procedures, having as primary aim functional restoration achieving aesthetic balanced facial features. This paper summarizes current knowledge in facial paralysis reconstruction and presents an algorithmic approach that eases decision making and therapeutic strategy. [ABSTRACT FROM AUTHOR]

The field of transplantation, including the specialized area of vascularized composite allotransplantation (VCA), has been transformed since the first hand transplant in 1998. The major challenge in VCA comes from the need for life-long immunosuppressive therapy due to its non-vital nature and a high rate of systemic complications. Ongoing research is focused on immunosuppressive therapeutic strategies to avoid toxicity and promote donor-specific tolerance. This includes studying the balance between tolerance and effector mechanisms in immune modulation, particularly the role of costimulatory signals in T lymphocyte activation. Costimulatory signals during T cell activation can have either stimulatory or inhibitory effects. Interfering with T cell activation through costimulation blockade strategies shows potential in avoiding rejection and prolonging the survival of transplanted organs. This review paper aims to summarize current data on the immunologic role of costimulatory blockade in the field of transplantation. It focuses on strategies that can be applied in vascularized composite allotransplantation, offering insights into novel methods for enhancing the success and safety of these procedures. [ABSTRACT FROM AUTHOR]

Introduction. The field of composite tissue allotransplatation became a clinical reality since first hand transplant performed in 1998 at Lyon, France and has been progressing over the past two decades. Vascularized composite allotransplantation (VCA) is now performed for life enhancing indications in a selected group of patients under institutional protocols. Aim. This paper is an attempt to review the outcomes of VCA to date. Method. Analysis of relevant publications of composite tissue allotransplantation was performed, including the International Registry on Hand and Composite Tissue Transplantation (IRHCTT). Results and discussion. To date, there are more than 200 composite tissue allograft transplants performed worldwide, including upper limb, face, larynx, trachea, abdominal wall, lower limb, penis, and uterus. The technical aspects of VCA are no longer the factors limiting the widespread application of this treatment modality in the clinical setting. The feasibility of the procedure has been established, and the functional outcomes have been very good so far. The major challenge is at the immunologic level, long-term goal being to promote donor-specific tolerance and to avoid the toxicity of immunosuppression. Conclusions. Vascularized composite allografts transplatation is a viable treatment option well on the way of becoming a standard of care for those who have lost extremities and suffered large tissue defects. The initial ethical dilemmas and concerns of safety and feasibility have been overcome recently and with further standardized surgical and immunological protocols the field is likely to grow significantly in the future. [ABSTRACT FROM AUTHOR]

Electrocutions are a particular type of trauma, usually affecting young active people, leading to high morbidity and mortality rates in extensive injured patients. Those patients require complex, multidisciplinary treatment in specialized burn centers. We conducted a three-year retrospective study in the Burn Unit of the Clinical Emergency Hospital Bucharest, Romania, aiming to identify different factors that characterize electrical injuries, with the goal to improve our clinical practice, in order to decrease overall complications, the morbidity and mortality rates and obtain an optimal functional prognosis for those severely injured patients. Patient-related and injury-related parameters were analyzed, and particularities observed in our burn unit were noted. A clear understanding of the physiopathology of those injuries and their complications is essential for providing an optimal therapeutic strategy. Rapid initiation of systemic supportive measures, accurate diagnostic and an adequate surgical treatment, correctly conducted, are essential for improving the vital and functional prognostic of patients who suffer electric injuries. [ABSTRACT FROM AUTHOR]