[Experimental and clinical experience of composite tissues allotransplantation in reconstructive surgery]

[Retrospective study of third degree cervico-facial burns]

INTRODUCTION

Cervical and facial burns can be responsible of social and professional exclusions, functional limitations and psychological repercussions. Composite allotransplantation has become a reality for complex facial reconstructions. The purpose of this study is to evaluate the sequelae of third degree facial burns that might fit into a facial transplant program.

PATIENTS AND METHODS

We conducted a retrospective study in our burn unit from May 2006 to July 2009. We included all the patients with third degree cervico-facial burns. One hundred and eighty seven patients were selected. We excluded 87 patients for insufficient initial photography or lack in the medical data. The topography of the facial burns was analysed for each patient and separated into different aesthetic sub units. A questionnaire was mailed to the patients evaluating the psychological, functional and aesthetic sequelae.

RESULTS

The follow-up was of 12 months at least. Of the 100 patients, 82 presented with partial facial burns and 18 with full facial burns. Of the 82 patients with partial burns, 48% had burns in the chin area, 45% in the neck area, 41% in the cheeks and 37% in the ears. The sub units associated with functional sequelae were the neck (32%) and the peri-buccal and peri-orbital region (11-14%). On the 100 questionnaires, 28 patients responded.

CONCLUSION

Third degree burns sequelae concerned mainly the neck and the lower third of the face. The indication of facial allotransplantation remains rare in the burn patient. The deep carbonisation and the very extensive burn patient with severe functional sequelae where the standard reconstructive procedures are inefficient might be eligible for a facial allotransplant program.

[From the first face replants operations to the first total face transplant: the history of surgical prowess]

Composite tissue allografts of the face were considered as science-fiction just a decade ago. They have become wonderful realities in our hospitals. Face transplantation is one of the great scientific adventures of the 21(th) century that history will remember. Physicians dreamed to give a new face to disfigured patients. Allografts of the face have become a reality thanks to breakthroughs in anatomy and plastic surgery, HLA system research, microsurgery, neurology, and immunosuppressive molecules. In 2010, two teams performed the first total face transplants in the world. They represent technical milestones in the history of transplantation. These face transplants, which have raised a lot of controversy and ethical questions, open the way for other surgical perspectives, allowing medicine to write new history, and show that progress is also made through transgression.

[To cure: to become oneself or become different?]

The parallel evolution of lifestyles and medicine calls into question the objectives of the therapeutical relationship. Leading-edge technology, the allotransplant radically questions what curing means: is it about becoming oneself again or another person? This paper studies this dilemma from three standpoints. First, in an aesthetics perspective, the transplant surgery refers to an implicit definition of what is an acceptable body, which introduces a tension between vascular supply, immunology and beauty. How far can we favour one or the other? Secondly, in a religious perspective, transplant contributes to the mimetic desire: how can we regulate this desire in a society that increasingly values the body? Finally, from a philosophical standpoint, allotransplant questions my personal relationship with my body: beyond its technological requirements, we have to determine, in the public and private spheres, if individuals have or are bodies. What responsibility does medicine assume, as an institution and a community of agents, in this anthropological choice?