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The plastic model experiment represents an idealized procedure with highly accurate patient-to-model registration error (0.727 mm and 0.306 mm for the plastic skull model donor and recipient, compared with 1.22 mm and 0.745 mm for the human cadaver donor and recipient, respectively), leading to improved tracking of the donor fragment when placing on the recipient. This achieves improved accuracy in comparing intraoperative to postoperative cephalometric measurements. The largest error comparing planned to posttransplant measurements in the plastic skull model (B–A, 1.97 mm) is on par with the largest error exhibited by the control measure (Go–Me, 2.24 mm). As such, the plastic model experiment may represent the potential best-case scenario for real-time cephalometry. The human cadaver experiment comparison of post–face-jaw-teeth transplantation and planned outcome measurements showed large differences in Me–Na (5.98 mm), and SNA (4.33 degrees)/SNB (3.03 degrees) angles (Table 5). In the comparison of predicted intraoperative values relative to obtained postoperative values, overbite (3.65 mm), B–A (5.31 mm), Me–ANS (4.38 mm), and Me–Na (5.98 mm) showed the greatest variation (Table 5). The error associated with these measurements comes mainly from two sources: (1) landmark identification error and (2) navigation and registration error. Landmark identification error has been the subject of many studies.27–30 A meta-analysis of several studies on landmark identification and reproducibility showed total identification error of approximately 0.81 mm,31 which is similar to the control error for the plastic Fig. 6. Lateral view of the human cadaver before transplantation (donor and recipient), after transplantation, and the planned outcome. The red dots denote the measured landmark positions in each model (above). Frontal three-dimensional reconstruction of the human cadaver recipient before transplantation, after transplantation, planned outcome, and donor before transplantation. Note the sites of rigid fixation in a Le Fort–based face-jaw-teeth transplantation. The red dots denote the measured landmark positions in each model (below). Frontal three-dimensional reconstruction of the human cadaver recipient post-facial transplantation (top) using real-time cephalometry and computer-assisted technology versus the planned outcome (bottom). Of note, the red dots denote the measured landmark positions used for cephalometric analysis and technology development. Copyright © 2015 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. Volume 136, Number 2 • Hybrid Occlusion and Cephalometry 357 experiment, which did not show any deviations greater than 3 mm or 2 degrees from target measurements (Table 5). The plastic model experiment represents an idealized procedure with highly accurate patient-to-model registration error (0.727 mm and 0.306 mm for the plastic skull model donor and recipient, compared with 1.22 mm and 0.745 mm for the human cadaver donor and recipient, respectively), leading to improved tracking of the donor fragment when placing on the recipient. This achieves improved accuracy in comparing intraoperative to postoperative cephalometric measurements. The largest error comparing planned to posttransplant measurements in the plastic skull model (B–A, 1.97 mm) is on par with the largest error exhibited by the control measure (Go–Me, 2.24 mm). As such, the plastic model experiment may represent the potential best-case scenario for real-time cephalometry. The human cadaver experiment comparison of post–face-jaw-teeth transplantation and planned outcome measurements showed large differences in Me–Na (5.98 mm), and SNA (4.33 degrees)/SNB (3.03 degrees) angles (Table 5). In the comparison of predicted intraoperative values relative to obtained postoperative values, overbite (3.65 mm), B–A (5.31 mm), Me–ANS (4.38 mm), and Me–Na (5.98 mm) showed the greatest variation (Table 5). The error associated with these measurements comes mainly from two sources: (1) landmark identification error and (2) navigation and registration error. Landmark identification error has been the subject of many studies.27–30 A meta-analysis of several studies on landmark identification and reproducibility showed total identification error of approximately 0.81 mm,31 which is similar to the control error for the plastic Fig. 6. Lateral view of the human cadaver before transplantation (donor and recipient), after transplantation, and the planned outcome. The red dots denote the measured landmark positions in each model (above). function.” Illustration depicting penile transplantation ILLUSTRATION BY TIM PHELPS Exploring the Vanguard of Transplantation: Hand, Face and Urogenital RECONSTRUCTIVE TRANSPLANT 8 | Plastic and Reconstructive Surgery W. P. Andrew Lee, M.D. The Milton T. Edgerton, M.D., Professor and Director Department of Plastic and Reconstructive Surgery MD: Johns Hopkins University School of Medicine General surgery residency: The Johns Hopkins Hospital Plastic surgery residency: Massachusetts General Hospital Hand surgery fellowship: Indiana Hand Center Expertise: hand transplant; immune modulation; hand and upper extremity surgery Accomplishments: Distinguished Alumnus Award by Johns Hopkins University (2015); Research Achievement Award for Basic Research from the American Association of Plastic Surgeons (2014); the Andrew J. Weiland Medal for Outstanding Research from the American Society for Surgery of the Hand (2014); led the surgical team that performed the nation’s first double-hand transplant in 2009 and the first trans-humeral transplant in 2010; chair of Plastic Surgery Research Council (2001-2); president of the American Society for Surgery of the Hand (2011–12); chair of the American Board of Plastic Surgery (2012–13); president of American Society of Reconstructive Transplantation (2014-16) Gerald Brandacher, M.D. Scientific Director, Vascularized Composite Allotransplantation Program Associate Professor of Plastic and Reconstructive Surgery MD: School of Medicine, Leopold Franzens University, Innsbruck, Austria General and transplant surgery residency: Innsbruck Medical University, Austria Expertise: vascularized composite allotransplantation (VCA); solid organ transplantation; transplant immunology Accomplishments: helped design a novel, cell-based immunomodulatory treatment protocol for VCA; member of the team performing the first bilateral hand transplant and first forearm transplant in the U.S.; research on donor-specific immune tolerance and immunomonitoring strategies for hand and face transplant; chair of the American Society of Transplantation VCA Advisory Council, chair of VCA Committee of the European Society of Organ Transplantation, treasurer of American Society of Reconstructive Transplantation; co-founder and Editor-in-Chief Vascularized Composite Allotransplantation (VCA) journal; selected as a “Fellow of the American Society of Transplantation (FAST)” (2015) Kristen Parker Broderick, M.D. Assistant Professor of Plastic and Reconstructive Surgery MD: Texas A&M University General surgery residency: University of North Carolina Hospital Plastic surgery residency: New York Presbyterian Hospital Weill Cornell/Columbia Breast reconstruction fellowship: Washington University St. Louis Expertise: breast reconstruction, cosmetic breast surgery, microvascular reconstruction, body contouring Accomplishments: numerous clinical and leadership awards and recognitions Julie Caffrey, D.O., M.S. Assistant Professor of Plastic and Reconstructive Surgery DO: Philadelphia College of Osteopathic Medicine MS: Philadelphia College of Osteopathic Medicine General surgery residency: Flushing Hospital Medical Center Burn Fellowships: Westchester Medical Center and The Johns Hopkins University Expertise: adult and pediatric acute burn injury, burn reconstruction, laser therapy forpost-burn scar contractures and hypertrophic scarring, surgical management of hidradentitis suppurativa Accomplishments: researching laser therapy for hypertrophic scarring after burn injury, establishing educational curriculum in burn Carisa Cooney, M.P.H., C.C.R.P. Assistant Professor of Plastic and Reconstructive Surgery and Clinical Research Manager BA: Kenyon College; Gambier, OH MPH: University of Illinois; Springfield, IL Expertise: clinical research on abdominal surgery wound therapy, vascularized composite allo-transplantation (VCA), and breast reconstruction outcomes; enhancement of resident physician education Accomplishments: original publications and ongoing research grants on improving patient outcomes after plastic and reconstructive surgery and on enhancing residency training Damon S. Cooney, M.D., Ph.D. Assistant Professor of Plastic and Reconstructive Surgery MD: University of Oklahoma Health Sciences Center PhD: Ohio State University Plastic surgery residency: Southern Illinois University School of Medicine Microsurgery fellowship: University of Pittsburgh Medical Center Expertise: general plastic surgery; microvascular reconstruction after breast cancer, head and neck cancer and trauma; hand surgery; reconstructive transplantation Accomplishments: research on vascularized composite allo-transplantaion (VCA); engineering human tissues for reconstructive purposes and nerve regeneration; microsurgical education; hand, face, and penile transplantation clinical trials Amir H. Dorafshar, M.B.Ch.B. Associate Professor of Plastic and Reconstructive Surgery Clinical Co-Director, Face Transplant Program MBChB: University of Manchester, United Kingdom General surgery residency: University of Chicago Medical Center Plastic surgery residency: University of Chicago Medical Center Vascular surgery research fellowship: University of California Los Angeles Craniofacial surgery and microsurgery fellowship: The Johns Hopkins Hospital and R Adams Cowley Shock
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