BACKGROUND: The authors report the technical difficulties involved in the procurement of a total human face graft for allotransplantation. METHODS: After completing a preclinical study that involved 13 fresh cadavers, the authors harvested a total face graft for allotransplantation onto a patient in April of 2009. The harvested tissue specimen included the entire face along with the scalp and the auricles. The authors then removed the unnecessary parts, specifically, the lips and the skin overlying the chin. RESULTS: The preclinical study and clinical results confirmed that complete revascularization of a total face graft, complete with the scalp and auricles, from a single external carotid vascular pedicle was possible. All dissections were completed in less than 6 hours during the preclinical study. Graft procurement for the clinical case took 11 hours. Facial soft tissues were harvested en bloc to decrease graft harvest time and prevent tissue injury. A resin mask that covered the entire face of the donor provided excellent cosmetic results. All nerves and eyelid structures were easily reattached. One month after transplantation, skin necrosis necessitated several stages of excision. Biopsy specimens from the transplanted tissue were negative for immune-mediated rejection. Unfortunately, the patient experienced a cardiac arrest during follow-up surgery and died 2 months after the transplant procedure. CONCLUSIONS: A composite tissue allotransplantation of the total face along with the scalp and the auricles is technically feasible. The authors' flap provided reliable vascularization and was obtained in a standardized fashion in less than 11 hours. The graft contained all of the perioral muscles, branches of the facial nerve, eyelid structures, and major salivary glands.
BACKGROUND: The authors report the technical difficulties involved in the procurement of a total human face graft for allotransplantation. METHODS: After completing a preclinical study that involved 13 fresh cadavers, the authors harvested a total face graft for allotransplantation onto a patient in April of 2009. The harvested tissue specimen included the entire face along with the scalp and the auricles. The authors then removed the unnecessary parts, specifically, the lips and the skin overlying the chin. RESULTS: The preclinical study and clinical results confirmed that complete revascularization of a total face graft, complete with the scalp and auricles, from a single external carotid vascular pedicle was possible. All dissections were completed in less than 6 hours during the preclinical study. Graft procurement for the clinical case took 11 hours. Facial soft tissues were harvested en bloc to decrease graft harvest time and prevent tissue injury. A resin mask that covered the entire face of the donor provided excellent cosmetic results. All nerves and eyelid structures were easily reattached. One month after transplantation, skin necrosis necessitated several stages of excision. Biopsy specimens from the transplanted tissue were negative for immune-mediated rejection. Unfortunately, the patient experienced a cardiac arrest during follow-up surgery and died 2 months after the transplant procedure. CONCLUSIONS: A composite tissue allotransplantation of the total face along with the scalp and the auricles is technically feasible. The authors' flap provided reliable vascularization and was obtained in a standardized fashion in less than 11 hours. The graft contained all of the perioral muscles, branches of the facial nerve, eyelid structures, and major salivary glands.
Authors: S Soga; B Pomahac; N Wake; K Schultz; R F Prior; K Kumamaru; M L Steigner; D Mitsouras; J Signorelli; E M Bueno; D S Enterline; F J Rybicki Journal: AJNR Am J Neuroradiol Date: 2012-08-09 Impact factor: 3.825
Authors: John T Nguyen; Yoshitomo Ashitate; Vivek Venugopal; Florin Neacsu; Frank Kettenring; John V Frangioni; Sylvain Gioux; Bernard T Lee Journal: J Surg Res Date: 2013-05-10 Impact factor: 2.192
Authors: Edward H Davidson; Eric W Wang; Jenny Y Yu; Juan C Fernandez-Miranda; Dawn J Wang; Yang Li; Maxine Miller; Wesley N Sivak; Debra Bourne; Hongkun Wang; Mario G Solari; Joel S Schuman; Kia M Washington Journal: J Craniofac Surg Date: 2016-10 Impact factor: 1.046
Authors: Christian Andreas Radu; Jurij Kiefer; Dominik Horn; Martin Rebel; Eva Koellensperger; Martha Maria Gebhard; Henning Ryssel; Guenter Germann; Matthias Artur Reichenberger Journal: Eplasty Date: 2011-09-15
Authors: Simone La Padula; Rosita Pensato; Chiara Pizza; Edoardo Coiante; Giovanni Roccaro; Benedetto Longo; Francesco D'Andrea; Francesco Saverio Wirz; Barbara Hersant; Jean Paul Meningaud Journal: J Clin Med Date: 2022-09-28 Impact factor: 4.964