"Time is the healer": McIndoe's guinea pigs fifty years on

The Surgeon's Role and Responsibility in Facial Tissue Allograft Transplantation

Facial composite tissue allograft (CTA) transplantation represents a novel frontier in the reconstruction of the human form. The face plays a central role in human interactions, with significant social ramifications resulting from facial disfigurement. The surgeon performing facial tissue transplantation bears additional responsibilities unique to plastic and reconstructive procedures. Reconstruction by facial tissue transplantation may immensely improve quality of life, provided the process of patient selection is conspicuous and appropriate and allograft rejection is prevented. However, facial CTA transplantation represents an elective procedure to reconstruct a non-life-threatening defect. Given the potential for organ failure, opportunistic infection, and malignancy resulting from long-term immunosuppression, the surgeon must carefully weigh the balance of risk to benefit for the individual patient. Pioneering surgeons developing this procedure must thoroughly evaluate its impact as it relates to clinical and social issues.