Andrew J Lindford1, Heikki Mäkisalo2, Hannu Jalanko3, Jouni Lauronen4, Veli-Jukka Anttila5, Susanna Juteau6, Antti-Jussi Ämmälä7, Anna Eskola7, Samuli Saarni8, Helena Isoniemi2, Antti Mäkitie9, Patrik Lassus10. 1. Department of Plastic Surgery, Töölö Hospital, Helsinki University Hospital (HUS), University of Helsinki, Topeliuksenkatu 5, P.O. Box 266, FIN-00029, Helsinki, Finland. Electronic address: andrew.lindford@hus.fi. 2. Transplantation and Liver Surgery Clinic, Helsinki University Hospital, University of Helsinki, Finland. 3. Department of Pediatric Nephrology and Transplantation, Children's Hospital, Helsinki University Hospital, Finland. 4. Finnish Red Cross Blood Service, Helsinki, Finland. 5. Department of Infectious Diseases, Helsinki University Hospital, University of Helsinki, Finland. 6. Department of Pathology, Haartman Institute, University of Helsinki & HUSLAB, Helsinki, Finland. 7. Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Finland. 8. Department of Health, Unit of Mental Health, National Institute for Health and Welfare, Helsinki, Finland; Turku University Hospital, University of Turku, Turku, Finland. 9. Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland. 10. Department of Plastic Surgery, Töölö Hospital, Helsinki University Hospital (HUS), University of Helsinki, Topeliuksenkatu 5, P.O. Box 266, FIN-00029, Helsinki, Finland.
Abstract
AIM: We herein describe the establishment of the Helsinki Vascularized Composite Allotransplantation (VCA) program and its execution in the first two face transplant cases. METHODS & PATIENTS: The Helsinki VCA program initially required the fulfillment of legal, hospital, financial, and ethical requirements. Thereafter, the assembling of a multidisciplinary team commenced. A team of Plastic, maxillofacial and ENT surgeons comprise the facial VCA team. The protocol involves collaboration with the Solid Organ Transplant (SOT) team, transplant immunology, immunosuppression, microbiology, psychiatric evaluation, well-defined VCA indications and informed consent. Between 2011 and 2017 two patients were selected for transplantation. Both patients had a severe composite facial deformity involving the maxilla and mandible following earlier ballistic injury. RESULTS: Patient 1 was a 35 year-old male who underwent successful near total face transplantation in February 2016 and at 30 months he has a good aesthetic outcome with symmetrical restoration of the central face and good sensory and symmetrical motor functional outcomes. Patient 2 was a 58 year-old male who underwent full face transplantation in March 2018 and at 5 months he has recovered without major problems. CONCLUSION: A successful facial VCA program requires a well-prepared research protocol, experts from multiple specialties and careful patient selection. The establishment of the Helsinki VCA program required long and thorough planning and resulted in the first two Nordic face transplantation cases. This protocol now forms the platform (as a proof of concept) for other types of vascularized composite allotransplantations.
AIM: We herein describe the establishment of the Helsinki Vascularized Composite Allotransplantation (VCA) program and its execution in the first two face transplant cases. METHODS & PATIENTS: The Helsinki VCA program initially required the fulfillment of legal, hospital, financial, and ethical requirements. Thereafter, the assembling of a multidisciplinary team commenced. A team of Plastic, maxillofacial and ENT surgeons comprise the facial VCA team. The protocol involves collaboration with the Solid Organ Transplant (SOT) team, transplant immunology, immunosuppression, microbiology, psychiatric evaluation, well-defined VCA indications and informed consent. Between 2011 and 2017 two patients were selected for transplantation. Both patients had a severe composite facial deformity involving the maxilla and mandible following earlier ballistic injury. RESULTS:Patient 1 was a 35 year-old male who underwent successful near total face transplantation in February 2016 and at 30 months he has a good aesthetic outcome with symmetrical restoration of the central face and good sensory and symmetrical motor functional outcomes. Patient 2 was a 58 year-old male who underwent full face transplantation in March 2018 and at 5 months he has recovered without major problems. CONCLUSION: A successful facial VCA program requires a well-prepared research protocol, experts from multiple specialties and careful patient selection. The establishment of the Helsinki VCA program required long and thorough planning and resulted in the first two Nordic face transplantation cases. This protocol now forms the platform (as a proof of concept) for other types of vascularized composite allotransplantations.
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