You will be required to give a short presentation on a variety of topics related to plastic surgery to two members of the interview panel. The presentation is for a duration of 5 minutes. The topic is as given below:
Title: Should composite tissue allotransplantation be offered on the NHS? Discuss
You have 5 minutes to prepare brief notes on the topic before you give your presentation. You may be asked questions at the end of the presentation.
Good morning my name is Joe Bloggs. I am currently a core trainee/registrar in plastic surgery and I will be making my case as to whether composite tissue allotransplantion should be offered on the NHS.
What is it?
Composite tissue allotransplantation refers to the transfer of composite tissue that may include skin, muscle, bone and nerve from one individual to another. The best examples include face, hand and abdominal wall transplantation. In the UK hand transplants have been performed in Liverpool by Prof Simon Kay's team and Abdominal Wall transplants have been performed by Henk Giele's team in Oxford.
Why is it important?
It promises to be a revolutionary advance in reconstruction by offering a complete "replacement part" for tissues compromised by disease or trauma.
- Composite tissue allotransplantation gives patients with missing structures a second chance
- It may have a drastic impact on quality of life and restores the patient's form and function
- Improve pyschological well-being
- Highest level of surgical challenge which we as surgeons enjoy
- Difficult to organise -> several ethical and practical issues around obtaining tissue and transferring it to the appropriate place
- Immunosuppressive regimens have improved but they still may have profoundly negative implications including increased incidence of opportunistic infections, increased risk of malignancies, and end-organ toxicity.
- Immunosuppressive side-effects may potentially offset positive quality-of-life/psychological status
- It should be offered on the NHS and is has in fact a handful of cases have been performed on the NHS. Hand transplants in Liverpool and abdominal wall transplants in Oxford have been performed respectively, as it has the potential to restore function and help make patients independent.
- However I believe the process for obtaining transplantable parts should be stream-lined to make it less bureaucratic.
- The procedures should only be performed in specialized units with the required expertise
- And it is important that we continue research into this area on several fronts including graft rejection and immunology, patient reported outcomes and surgical techniques before adopting it onto the portfolio of surgical procedures offered on the NHS.
In summary composite tissue allotransplantation can provide significant benefits for patients, however they face a number of challenges on several fronts. I believe they should be offered on the NHS but only with careful vetting at every step of the process.
Petit F, Minns AB, Dubernard JM, Hettiaratchy S, Lee WP. Composite tissue
allotransplantation and reconstructive surgery: first clinical applications. Ann Surg. 2003 Jan;237(1):19-25. Review.