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Ozmen S, Findikcioglu K, Sibar S, Tuncer S, Ayhan S, Guz G, Unal Y, Aslan S. First Composite Woman-to-Woman Facial Transplantation in Turkey: Challenges and Lessons to Be Learned. Ann Plast Surg 2023; 90:87-95. [PMID: 36534107 DOI: 10.1097/sap.0000000000003323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT After the first face transplantation from woman to woman we performed in our clinic, it was aimed to eliminate the lack of knowledge about the subject in the literature by transferring our experiences and long-term results to the problems we had with the patient. A 20-year-old patient underwent partial osteomyocutaneous facial transplant (22nd facial transplant), which included 2 functional units of the face. The patient had no major problems in the early period and had a good aesthetic appearance. In the postoperative period, the patient ended her social isolation and adopted the transplanted face.In the late period, secondary surgical interventions, management of the problems caused by immunosuppression, and the patient's living in a remote location to our clinic were the difficulties encountered. Six revision surgeries were performed after the transplantation. Due to immunosuppression, opportunistic infections and metabolic problems required intermittent hospitalization. The patient died at the end of 56 months because of complications secondary to immunosuppression.A successful transplant involves the management of long-term problems rather than a successful tissue transfer in the early period. In today's conditions, long-term success can be achieved with a good patient compliance, as well as each team member should take an active role in the team at the transplantation centers. More case series are needed to adapt the standard treatment and follow-up protocols for solid organ transplantations for composite tissue allotransplantations. This will be possible by sharing the results and experiences transparently in the centers where face transplantation is performed worldwide.
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Affiliation(s)
- Selahattin Ozmen
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Koç University Hospital, Istanbul
| | | | - Serhat Sibar
- Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Serhan Tuncer
- Departments of Plastic, Reconstructive and Aesthetic Surgery
| | - Suhan Ayhan
- Departments of Plastic, Reconstructive and Aesthetic Surgery
| | | | | | - Selcuk Aslan
- Psychiatry, Gazi University Hospital, Ankara, Turkey
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2
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Facial Transplantation. Facial Plast Surg Clin North Am 2022; 30:255-269. [DOI: 10.1016/j.fsc.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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3
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Modified Le Fort II approach of adequate vascularization preservation in midface allotransplantation: Mock surgery. Asian J Surg 2021; 45:1259-1262. [PMID: 34656408 DOI: 10.1016/j.asjsur.2021.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION It is critical to preserve adequate vascularization in midface allotransplantation, the major complication of which is inadequate blood supply in palate area supplying mainly by internal maxillary artery. Therefore, the aim of this study is to explore a modified Le Fort II approach entailing midface vascularization enhancement. MATERIALS AND METHODS Ten cadaveric heads were used in mock surgery. A conventional approach was used on seven cadaveric heads to harvest external carotid artery-facial artery-internal maxillary artery axis. On the remaining three cadaveric heads, modified Le Fort II approach was applied where the internal maxillary artery was harvested after cutting off zygomatic arches and rami of the mandible. RESULTS The conventional approach had difficulty harvesting internal maxillary artery, which left the facial artery the only blood supply to midface. Modified Le Fort II approach with Computerized surgical planning (CSP) assisted, on the other hand, could completely unveil and harvest intact internal maxillary artery after osteotomy of mandibular ramus. CONCLUSION The modified Le Fort II approach with CSP and ultrasonic bone cutter assisted can maximally preserve internal maxillary system with ease. This approach optimizes midface allotransplantation in clinical practice in future.
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Vincent AG, Gunter AE, Ducic Y, Reddy L. Maxillofacial Bony Considerations in Facial Transplantation. Facial Plast Surg 2021; 37:735-740. [PMID: 33878799 DOI: 10.1055/s-0041-1726443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Alloplastic facial transplantation has become a new rung on the proverbial reconstructive ladder for severe facial wounds in the past couple of decades. Since the first transfer including bony components in 2006, numerous facial allotransplantations across many countries have been successfully performed, many incorporating multiple bony elements of the face. There are many unique considerations to facial transplantation of bone, however, beyond the considerations of simple soft tissue transfer. Herein, we review the current literature and considerations specific to bony facial transplantation focusing on the pertinent surgical anatomy, preoperative planning needs, intraoperative harvest and inset considerations, and postoperative protocols.
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Affiliation(s)
| | - Anne E Gunter
- Department of Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | | | - Likith Reddy
- Department of Oral and Maxillofacial Surgery, Texas A&M Health Science Center, Dallas, Texas
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Anesthetic Considerations in Facial Transplantation: Experience at NYU Langone Health and Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2955. [PMID: 32983760 PMCID: PMC7489595 DOI: 10.1097/gox.0000000000002955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/08/2020] [Indexed: 01/18/2023]
Abstract
Anesthetic considerations are integral to the success of facial transplantation (FT), yet limited evidence exists to guide quality improvement. This study presents an institutional anesthesia protocol, defines reported anesthetic considerations, and provides a comprehensive update to inform future directions of the field.
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Dorante MI, Kollar B, Obed D, Haug V, Fischer S, Pomahac B. Recognizing Emotional Expression as an Outcome Measure After Face Transplant. JAMA Netw Open 2020; 3:e1919247. [PMID: 31940037 PMCID: PMC6991259 DOI: 10.1001/jamanetworkopen.2019.19247] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE Limited quantitative data exist on the restoration of nonverbal communication via facial emotional expression after face transplant. Objective and noninvasive methods for measuring outcomes and tracking rehabilitation after face transplant are lacking. OBJECTIVE To measure emotional expression as an indicator of functional outcomes and rehabilitation after face transplant via objective, noninvasive, and nonobtrusive software-based video analysis. DESIGN, SETTING, AND PARTICIPANTS This single-center case-control study analyzed videos with commercially available video analysis software capable of detecting emotional expression. The study participants were 6 patients who underwent face transplant at Brigham and Women's Hospital between April 2009 and March 2014. They were matched by age, race/ethnicity, culture, and sex to 6 healthy controls with no prior facial surgical procedures. Participants were asked to perform either emotional expressions (direct evaluation) or standardized facial movements (indirect evaluation). Videos were obtained in a clinical setting, except for direct evaluation videos of 3 patients that were recorded at the patients' residences. Data analysis was performed from June 2018 to November 2018. MAIN OUTCOMES AND MEASURES The possibility of detecting the emotional expressions of happiness, sadness, anger, fear, surprise, and disgust was evaluated using intensity score values between 0 and 1, representing expressions that are absent or fully present, respectively. RESULTS Six patients underwent face transplant (4 men; mean [SD] age, 42 [14] years). Four underwent full face transplants, and 2 underwent partial face transplants of the middle and lower two-thirds of the face. In healthy controls, happiness was the only emotion reliably recognized in both indirect (mean [SD] intensity score, 0.92 [0.05]) and direct (mean [SD] intensity score, 0.91 [0.04]) evaluation. Indirect evaluation showed that expression of happiness significantly improved 1 year after transplant (0.04 point per year; 95% CI, 0.02 to 0.06 point per year; P = .002). Expression of happiness was restored to a mean of 43% (range, 14% to 75%) of that of healthy controls after face transplant. The expression of sadness showed a significant change only during the first year after transplant (-0.53 point per year; 95% CI, -0.82 to -0.24 point per year; P = .005). All other emotions were detectable with no significant change after transplant. Nearly all emotions were detectable in long-term direct evaluation of 3 patients, with expression of happiness restored to a mean of 26% (range, 5% to 59%) of that of healthy controls. CONCLUSIONS AND RELEVANCE Partial restoration of facial emotional expression is possible after face transplant. Video analysis software may provide useful clinical information and aid rehabilitation after face transplant.
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Affiliation(s)
- Miguel I. Dorante
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Lahey Hospital and Medical Center, Department of Plastic and Reconstructive Surgery, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Branislav Kollar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Doha Obed
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Sebastian Fischer
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Hand, Plastic, and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Devauchelle B. [Facial allotransplantation: thinking beyond facial transplantation]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2019; 64:30-32. [PMID: 31783945 DOI: 10.1016/j.soin.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Allotransplantation of the face both summarises and deploys the history of organ transplantation. It's a history of successes and disappointments, bringing scientific advances and promises, but also calls for caution and consideration beyond transplantation.
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Affiliation(s)
- Bernard Devauchelle
- Chirurgie maxillo-faciale, CHU d'Amiens-Hôpital Nord, place Victor-Pauchet, 80054 Amiens cedex 1, France.
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8
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Rifkin WJ, David JA, Plana NM, Kantar RS, Diaz-Siso JR, Gelb BE, Ceradini DJ, Rodriguez ED. Achievements and Challenges in Facial Transplantation. Ann Surg 2019; 268:260-270. [PMID: 29489486 DOI: 10.1097/sla.0000000000002723] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
: The first facial transplantation in 2005 ushered in a new era in reconstructive surgery, offering new possibilities for the repair of severe disfigurements previously limited by conventional techniques. Advances in allograft design, computerized preoperative planning, surgical technique, and postoperative revisions have helped push the boundaries in this new frontier of vascularized composite allotransplantation. Over the past 12 years, 40 of these procedures have been performed across the world, offering the field the opportunity to reflect on current outcomes. Successes achieved in the brief history of facial transplantation have resulted in a new set of obstacles the field must now overcome. In this review, we aim to highlight the achievements, major challenges, and future directions of this rapidly evolving field.
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Affiliation(s)
- William J Rifkin
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health. New York, NY
| | - Joshua A David
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health. New York, NY
| | - Natalie M Plana
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health. New York, NY
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health. New York, NY
| | - J Rodrigo Diaz-Siso
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health. New York, NY
| | - Bruce E Gelb
- Division of Transplant Surgery, NYU Langone Health, New York, NY
| | - Daniel J Ceradini
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health. New York, NY
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health. New York, NY
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Touzet-Roumazeille S, Nicol P, Fontaine C, Vacher C. Anatomic study of the arterial territories of the face depending on the external carotid artery branches. Morphologie 2019; 104:38-43. [PMID: 31494018 DOI: 10.1016/j.morpho.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
AIM OF THE STUDY Blood supply of the skin of the face is mainly provided by 3 branches of the external carotid artery: facial artery (FA), superficial temporal artery (STA) and transverse facial artery (TFA) which is a branch of the STA. The aim of the study was to describe the arterial territories of the skin of the face depending on the external carotid branches. MATERIAL AND METHODS After dissection of the first two centimeters of these arteries on one side, we performed an injection of India ink of different colors in the arteries in order to describe the arterial territories (angiosomes) of the face on 24 embalmed cadavers. RESULTS The lips and the tip of the nose were vascularized in most cases by the FA. The STA vascularizes the temporal and frontal areas and a part of the auricle. The buccal area blood supply is coming from the FA with a participation of the TFA which is variable (10/24 cases), and the zygomatic area blood supply is coming from the STA with a participation of the TFA (9/24 cases). CONCLUSIONS Variations in the angiosomes of the face have to be considered in reconstructive surgery, and in face transplantation.
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Affiliation(s)
- S Touzet-Roumazeille
- Oral and Maxillofacial Department, Universitary Hospital of Lille, University of medicine of Lille, Place de Verdun, 59045 Lille cedex, France
| | - P Nicol
- Department of oral and maxillofacial surgery, Beaujon Hospital, AP-HP, 92110 Clichy, Paris, France; Department of Anatomy, University of medicine Paris Diderot, Beaujon Hospital, AP-HP, 100, boulevard Général Leclerc, 92110 Paris, France
| | - C Fontaine
- Department of anatomy, Faculty of Medecine Henri Warembourg, University of medicine of Lille, Place de Verdun, 59045 Lille cedex, France
| | - C Vacher
- Department of oral and maxillofacial surgery, Beaujon Hospital, AP-HP, 92110 Clichy, Paris, France; Department of Anatomy, University of medicine Paris Diderot, Beaujon Hospital, AP-HP, 100, boulevard Général Leclerc, 92110 Paris, France; EUniversité de Paris, EA2496, 92120 Montrouge, France.
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Computerized Approach to Facial Transplantation: Evolution and Application in 3 Consecutive Face Transplants. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2379. [PMID: 31592022 PMCID: PMC6756666 DOI: 10.1097/gox.0000000000002379] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/14/2019] [Indexed: 01/08/2023]
Abstract
Face transplant (FT) candidates present with unique anatomic and functional defects unsuitable for autologous reconstruction, making the accurate design and transplantation of patient-specific allografts particularly challenging. In this case series, we present our computerized surgical planning (CSP) protocol for FT.
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Distribution of the maxillary artery in the deep regions of the face and the maxilla: Clinical applications. J Plast Reconstr Aesthet Surg 2019; 72:1020-1024. [PMID: 30898500 DOI: 10.1016/j.bjps.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/26/2019] [Accepted: 02/17/2019] [Indexed: 11/20/2022]
Abstract
Composite tissue allotransplantation of the face has led to renewed interest in the vascularization of the maxilla. The maxillary artery, which is deep within the tissue and difficult to access, is considered the main artery of the maxilla. The objective of this study was to describe the distribution of the maxillary artery in the deep regions of the face and maxilla. Twenty-four maxillae were studied, of which 20 were injected with latex and four with India ink. The maxillary artery in the pterygopalatine fossa gave rise to the sphenopalatine artery, infraorbital artery, descending palatine artery, and posterior superior alveolar artery in all 24 cases. The posterior superior alveolar artery gave rise to a periosteal branch and an intraosseous branch (in the wall of the maxillary sinus) in 18 cases. The branch passed through part of the wall and the entire wall in eight and ten cases, respectively, and anastomosed at the anterior nasal spine and the infraorbital foramen. The descending palatine artery presented as a single trunk in four cases, a greater palatine artery and a lower palatine artery in 18 cases, and four branches in two cases. Intraosseous and periosteal anastomoses were found along with anastomosis through the incisive foramen, which were obstructed in three cases. The vascular territories were studied. The maxillary artery created an intraosseous and periosteal anastomotic network, explaining the supply pathways during different surgical procedures, risk of hemorrhage with orthognathic surgery (Le Fort type I) in a sinus lift for preimplant surgery, and the vascular territories.
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Tasigiorgos S, Kollar B, Krezdorn N, Bueno EM, Tullius SG, Pomahac B. Face transplantation-current status and future developments. Transpl Int 2018; 31:677-688. [DOI: 10.1111/tri.13130] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/21/2017] [Accepted: 02/02/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Sotirios Tasigiorgos
- Division of Plastic Surgery; Department of Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Branislav Kollar
- Division of Plastic Surgery; Department of Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery; Hannover Medical School; Hannover Germany
| | - Ericka M. Bueno
- Division of Plastic Surgery; Department of Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Stefan G. Tullius
- Division of Transplant Surgery; Department of Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Bohdan Pomahac
- Division of Plastic Surgery; Department of Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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Discussion: First Lower Two-Thirds Osteomyocutaneous Facial Allograft Perfused by a Unilateral Facial Artery: Outcomes and Vascularization at 1 Year after Transplantation. Plast Reconstr Surg 2017; 140:168-169. [PMID: 28654604 DOI: 10.1097/prs.0000000000003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Wiggenhauser PS, Schantz JT, Rotter N. Cartilage engineering in reconstructive surgery: auricular, nasal and tracheal engineering from a surgical perspective. Regen Med 2017; 12:303-314. [PMID: 28524733 DOI: 10.2217/rme-2016-0160] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This review provides an update on cartilage tissue engineering with particular focus on the head and neck. It is aimed at scientists and clinicians who are interested in tissue engineering and its clinical applicability. Principal tissue engineering strategies are summarized in the first part of this review. In the second part, current clinical approaches to auricular, nasal and tracheal reconstruction are discussed from a surgical perspective. By this approach, the requirements for clinical applicability are outlined and new insight into relevant aims of research is given to accelerate the transfer from bench to bedside.
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Affiliation(s)
- Paul Severin Wiggenhauser
- sup>Department of Oto-Rhino-Laryngology, Head & Neck Surgery, Ulm University Medical Center, Frauensteige 12, Ulm DE 89075, Germany.,Department of Hand, Plastic & Aesthetic Surgery, Ludwig Maximilian University of Munich, Pettenkoferstrasse 8a, Munich DE 80336, Germany
| | - Jan Thorsten Schantz
- Department of Plastic Surgery & Hand Surgery, München rechts der Isar, Technical University of Munich, Ismaninger Str. 22, Munich DE 81675, Germany
| | - Nicole Rotter
- Department of Hand, Plastic & Aesthetic Surgery, Ludwig Maximilian University of Munich, Pettenkoferstrasse 8a, Munich DE 80336, Germany
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First Lower Two-Thirds Osteomyocutaneous Facial Allograft Perfused by a Unilateral Facial Artery. Plast Reconstr Surg 2017; 139:1175e-1183e. [DOI: 10.1097/prs.0000000000003288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Skeletal Changes of an Osteomyocutaneous Facial Allograft Five Years Following Transplantation. J Craniofac Surg 2017; 28:352-358. [DOI: 10.1097/scs.0000000000003292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Herring SW, Ochareon P. The Periosteum of the Zygomatic Arch: Vascularization and Growth. Anat Rec (Hoboken) 2016; 299:1661-1670. [DOI: 10.1002/ar.23482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/05/2016] [Accepted: 04/12/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Susan W. Herring
- Department of Orthodontics; University of Washington; Seattle Washington
| | - Pannee Ochareon
- Department of Anatomy, Faculty of Dentistry; Mahidol University; Bangkok Thailand
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21
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Discussion: Vascular Perfusion of the Facial Skin: Implications in Allotransplantation of Facial Aesthetic Subunits. Plast Reconstr Surg 2016; 138:1080-1081. [PMID: 27783005 DOI: 10.1097/prs.0000000000002717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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23
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Management of the Salivary Glands and Facial Nerve in Face Transplantation. Plast Reconstr Surg 2016; 137:1887-1897. [DOI: 10.1097/prs.0000000000002179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Chang EI, Hanasono MM. State-of-the-art reconstruction of midface and facial deformities. J Surg Oncol 2016; 113:962-70. [DOI: 10.1002/jso.24150] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Edward I. Chang
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Matthew M. Hanasono
- Department of Plastic Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
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Abstract
BACKGROUND Devastating fourth-degree electrical injuries to the face and head pose significant reconstructive challenges. To date, there have been few peer-reviewed articles in the literature that describe those reconstructive challenges. The authors present the largest case series to date that describes the management of these injuries, including the incorporation of face transplantation. METHODS A retrospective case series was conducted of patients with devastating electrical injuries to the face who were managed at two level-1 trauma centers between 2007 and 2011. Data describing patient injuries, initial management, and reconstructive procedures were collected. RESULTS Five patients with devastating electrical injuries to the face were reviewed. After initial stabilization and treatment of life-threatening injuries, all five underwent burn excision and microsurgical reconstruction using distant flaps. Two of the patients eventually underwent face transplantation. The authors describe differences in management between the two trauma centers, one of which had the availability for composite tissue allotransplantation; the other did not. Also described is how initial attempts at traditional reconstruction affected the eventual face transplantation. CONCLUSIONS The care of patients with complex electrical burns must be conducted in a multidisciplinary fashion. As with all other trauma, the initial priority should be management of the airway, breathing, and circulation. Additional considerations include cardiac arrhythmias and renal impairment attributable to myoglobinuria. Before embarking on aggressive reconstruction attempts, it is advisable to determine early whether the patient is a candidate for face transplantation in order to avoid antigen sensitization, loss of a reconstructive "lifeboat," surgical plane disruption, and sacrifice of potential recipient vessels. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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27
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Diaz-Siso JR, Fischer S, Sisk GC, Bueno E, Kueckelhaus M, Talbot S, Carty MJ, Treister NS, Marty F, Milford EL, Pomahac B, Tullius SG. Initial experience of dual maintenance immunosuppression with steroid withdrawal in vascular composite tissue allotransplantation. Am J Transplant 2015; 15:1421-31. [PMID: 25777324 DOI: 10.1111/ajt.13103] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 01/25/2023]
Abstract
Current immunosuppression in VCA is largely based on the experience in solid organ transplantation. It remains unclear if steroids can be reduced safely in VCA recipients. We report on five VCA recipients who were weaned off maintenance steroids after a median of 2 months (mean: 4.8 months, range 2-12 months). Patients were kept subsequently on a low dose, dual maintenance consisting of tacrolimus and mycophenolate mofetil/mycophenloic acid with a mean follow-up of 43.6 months (median = 40 months, range 34-64 months). Early and late acute rejections responded well to temporarily augmented maintenance, topical immunosuppression, and/or steroid bolus treatment. One late steroid-resistant acute rejection required treatment with thymoglobulin. All patients have been gradually weaned off steroids subsequent to the treatment of acute rejections. Low levels of tacrolimus (<5 ng/mL) appeared as a risk for acute rejections. Although further experience and a cautious approach are warranted, dual-steroid free maintenance immunosuppression appears feasible in a series of five VCA recipients.
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Affiliation(s)
- J R Diaz-Siso
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Abstract
BACKGROUND Severe facial injuries can compromise the upper airway by reducing airway volume, obstructing or obliterating the nasal passage, and interfering with oral airflow. Besides the significant impact on quality of life, upper airway impairments can have life-threatening or life-altering consequences. The authors evaluated improvements in functional airway after face transplantation. METHODS Between 2009 and 2011, four patients underwent face transplantation at the authors' institution, the Brigham and Women's Hospital. Patients were examined preoperatively and postoperatively and their records reviewed for upper airway infections and sleeping disorders. The nasal mucosa was biopsied after face transplantation and analyzed using scanning electron microscopy. Volumetric imaging software was used to evaluate computed tomographic scans of the upper airway and assess airway volume changes before and after transplantation. RESULTS Before transplantation, two patients presented an exposed naked nasal cavity and two suffered from occlusion of the nasal passage. Two patients required tracheostomy tubes and one had a prosthetic nose. Sleeping disorders were seen in three patients, and chronic cough was diagnosed in one. After transplantation, there was no significant improvement in sleeping disorders. The incidence of sinusitis increased because of mechanical interference of the donor septum and disappeared after surgical correction. All patients were decannulated after transplantation and were capable of nose breathing. Scanning electron micrographs of the respiratory mucosa revealed viable tissue capable of mucin production. Airway volume significantly increased in all patients. CONCLUSIONS Face transplantation successfully restored the upper airway in four patients. Unhindered nasal breathing, viable respiratory mucosa, and a significant increase in airway volume contributed to tracheostomy decannulation.
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Touré G, Meningaud JP. Anatomical study of the vascular territories of the maxilla: role of the facial artery in allotransplantation. J Plast Reconstr Aesthet Surg 2014; 68:213-8. [PMID: 25455291 DOI: 10.1016/j.bjps.2014.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 05/28/2014] [Accepted: 10/04/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Facial composite tissue allotransplantation has recently become a surgical option. The maxilla, which forms the upper jaw and plays an important role in facial allotransplantation, consists of the maxillary and facial arteries. The maxillary artery is located deep within the tissue and considered the main artery of the maxilla; however, the facial artery is easy to access. The objective of this study was to examine the territories of the maxillary and facial arteries within the maxilla. MATERIALS AND METHODS We excised and examined 22 maxillae. Of these, 18 were injected with latex and four with India ink. RESULTS We observed that the ascending palatine artery, which was collateral with the facial artery, vascularized the maxilla through its dorsal part. The facial artery vascularized the maxilla through its ventral part with the philtral and columellar branches of the superior labial artery. Therefore, the facial artery formed, through the nasal and palatine mucosa, an arterial circle with a dorsal and ventral pole. Angiosomes formed by both the facial and maxillary arteries were also observed. The India ink injected into the facial and maxillary arteries delineated specific territories for each artery. DISCUSSION This study allowed us to determine the anatomical structures that provide vascularization to the maxilla and describe their different forms. The whole of the maxilla was vascularized by the facial artery, despite the caution imposed by several studies on the removal of the facial artery alone. Indeed, the removal technique was found to be safer when it preserved the anastomoses between the facial and maxillary arteries. Therefore, previous clinical experience and our anatomical study definitively demonstrate that the facial artery vascularizes the maxilla.
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Affiliation(s)
- Gaoussou Touré
- Department of Maxillofacial Surgery, CHI, Villeneuve Saint Georges, France; Department of Anatomy, URDIA, Paris, France.
| | - Jean-Paul Meningaud
- Department of Plastic Reconstructive and Esthetic Surgery, Université Paris 12, Faculty of Medicine, Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier, Créteil, France
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Facial Transplantation. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Busnardo FDF, Coltro PS, Olivan MV, Barreiro GC, Baptista RR, Ferreira MC, Gemperli R. Face transplantation in rats. Reproducibility of the experimental model in Brazil. Acta Cir Bras 2014; 29:532-7. [DOI: 10.1590/s0102-86502014000800009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/11/2014] [Indexed: 11/22/2022] Open
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Face transplantation: on the verge of becoming clinical routine? BIOMED RESEARCH INTERNATIONAL 2014; 2014:907272. [PMID: 25009821 PMCID: PMC4070394 DOI: 10.1155/2014/907272] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/15/2014] [Accepted: 05/21/2014] [Indexed: 11/24/2022]
Abstract
Introduction. Face transplantation (FT) is an innovative achievement of modern reconstructive surgery and is on the verge of becoming a common surgical opportunity. This review article was compiled to provide an update on this surgical field, especially regarding clinical outcomes, benefits, and complications implied. Methods. We performed an extensive research on all English-language Medline articles, case reports, and reviews published online until September 15, 2013. Used search terms were “face transplantation,” “face transplant,” “facial transplantation,” “facial transplant,” “face allograft,” and “facial allograft.” Results. To date 27 FTs have been performed worldwide. 19 of these cases have been published in the Medline database. Long-term follow-up reports of FT cases are rare. Three deaths associated with the procedure have occurred to date. The clinical outcomes of FT are satisfying. Reinnervation of sensation has been faster than motor recovery. Extensive functional improvements have been observed. Due to strict immunosuppression protocols, no case of hyperacute or chronic rejection and no graft-versus-host disease have occurred to date. Conclusions. As studies on long-term outcomes are missing, particularly regarding immunosuppression-related complications, FT will stay experimental for the next years. Nevertheless, for a small group of patients, FT already is a feasible reconstructive option.
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Abstract
PURPOSE OF REVIEW There have been 26 cases of facial transplantation reported, and three deaths, 11.5%. Mortality raises the issue of risk versus benefit for face transplantation, a procedure intended to improve quality of life, rather than saving life. Thus, one of the most innovative surgical procedures has opened the debate on the ethical, legal, and philosophical aspects of face transplantation. RECENT FINDINGS Morbidity in face transplant recipients includes infections and metabolic consequences. No graft loss caused by technical failure, hyperacute, or chronic graft rejection or graft-versus-host disease has been reported. One case of posttransplant lymphoproliferative disorder, 3.45% and one case of lymphoma in an HIV-positive recipient were reported. Psychological issues in candidates can include chronic pain, mood disorders, preexisting psychotic disorders, post-traumatic stress disorder (PTSD), and substance abuse. SUMMARY Early publications on ethical aspects of face transplantation focused mainly on informed consent. Many other ethical issues have been identified, including lack of coercion, donor family consent and confidentiality, respect for the integrity of the donor's body, and financial promotion of the recipient and transplant team, as well as the cost to society for such a highly technical procedure, requiring lifelong immunosuppression.
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Kumamaru KK, Sisk GC, Mitsouras D, Schultz K, Steigner ML, George E, Enterline DS, Bueno EM, Pomahac B, Rybicki FJ. Vascular communications between donor and recipient tissues after successful full face transplantation. Am J Transplant 2014; 14:711-9. [PMID: 24502329 DOI: 10.1111/ajt.12608] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 01/25/2023]
Abstract
The vascular reorganization after facial transplantation has important implications on future surgical planning. The purpose of this study was to evaluate blood flow (BF) after full face transplantation using wide area-detector computed tomography (CT) techniques. Three subjects with severe craniofacial injury who underwent full face transplantation were included. All subjects underwent a single anastomosis bilaterally of the artery and vein, and the recipient tongue was preserved. Before and after surgery, dynamic volume CT studies were analyzed for vascular anatomy and blood perfusion. Postsurgical CT showed extensive vascular reorganization for external carotid artery (ECA) angiosome; collateral flows from vertebral, ascending pharyngeal or maxillary arteries supplied the branches from the recipient ECAs distal to the ligation. While allograft tissue was slightly less perfused when the facial artery was the only donor artery when compared to an ECA-ECA anastomosis (4.4 ± 0.4% vs. 5.7 ± 0.7%), allograft perfusion was higher than the recipient normal neck tissue. BF for the recipient tongue was maintained from contralateral/donor arteries when the lingual artery was sacrificed. Venous drainage was adequate for all subjects, even when the recipient internal jugular vein was anastomosed in end-to-end fashion on one side. In conclusion, dynamic CT identified adequate BF for facial allografts via extensive vascular reorganization.
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Affiliation(s)
- K K Kumamaru
- Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
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de Taddéo A, Zwetyenga N, Trouilloud P, Trost O. Étude radio-anatomique tridimensionnelle de l’artère faciale et de ses perforantes cutanées. ANN CHIR PLAST ESTH 2014; 59:22-8. [DOI: 10.1016/j.anplas.2013.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/25/2013] [Indexed: 12/15/2022]
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Vascularization of the facial bones by the facial artery: implications for full face allotransplantation. Plast Reconstr Surg 2014; 133:1153-1165. [PMID: 24445880 DOI: 10.1097/prs.0000000000000111] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The maxillary artery is recognized as the main vascular supply of the facial bones; nonetheless, clinical evidence supports a codominant role for the facial artery. This study explores the extent of the facial skeleton within a facial allograft that can be harvested based on the facial artery. METHODS Twenty-three cadaver heads were used in this study. In 12 heads, the facial, superficial temporal, and maxillary arteries were injected. In one head, facial artery angiography was performed. Ten facial allografts were raised. The soft tissues were dissected to show the arterial anastomotic connections. Radiographs and computed tomographic scans were obtained. RESULTS Constant anastomosis between the facial, inferior alveolar, and infraorbital arteries at the mental and infraorbital foramina were found. The facial artery vascularized the homolateral mandibular symphysis, body, and ramus. The condylar and coronoid processes were vascularized in 67 percent of the allografts. The homolateral maxilla was contrasted in all allografts. The alveolar and palatine processes contained the contrast in 83 percent of specimens. The maxillary process of the zygomatic bone was perfused in all allografts, followed by the body, frontal (83 percent), and temporal processes (67 percent). The nasal lateral wall and septum were vascularized in 83 percent of the allografts. The medial and lateral orbital walls and the orbital floor were stained in all specimens. The zygomatic process of the temporal bone was the least perfused bone. CONCLUSION A composite allograft containing 90 to 95 percent of the facial bones can be based on bilateral facial arteries.
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Alam DS, Chi JJ. Facial Transplantation for Massive Traumatic Injuries. Otolaryngol Clin North Am 2013; 46:883-901. [DOI: 10.1016/j.otc.2013.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Concomitant Face/Upper Extremity Allotransplantation. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-012-0005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Craniomaxillofacial Allotransplantation: Achievements and Future Challenges. CURRENT SURGERY REPORTS 2012. [DOI: 10.1007/s40137-012-0006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Burns may represent one of the main indications for face allotransplantation. Severely disfigured faces featuring a devastating appearance and great functional impairments are not only seen as burn sequelae but also occur as a result of other traumatic injuries, oncological surgical resections, benign tumors (eg, neurofibromatosis), and major congenital malformations. To date, 20 human face composite tissue allotransplants have been performed with success. Despite the initial scepticism about its applicability, due mainly to ethical and technical reasons, the previous worldwide cases and their associated positive outcomes, including acceptable immunosuppressive regimens, excellent aesthetic and functional results, and good psychological acceptance by the recipient, enable the conclusion that face composite tissue allotransplantation has become another therapeutic strategy in the reconstructive surgical armamentarium, which bears special consideration when dealing with severely disfigured burned patients. The aim of this review is to describe the basics of face composite tissue allotransplantation and give an overview of some of the cases performed until now, with special attention paid to debating the pros and cons of its applicability in burn patients.
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Affiliation(s)
- Arno A
- Plastic Surgery Department and Burn Unit, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Barret JP
- Plastic Surgery Department and Burn Unit, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Harrison RA
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jeschke MG
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Soga S, Pomahac B, Wake N, Schultz K, Prior RF, Kumamaru K, Steigner ML, Mitsouras D, Signorelli J, Bueno EM, Enterline DS, Rybicki FJ. CT angiography for surgical planning in face transplantation candidates. AJNR Am J Neuroradiol 2012; 34:1873-81. [PMID: 22878008 DOI: 10.3174/ajnr.a3268] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
SUMMARY Facial allotransplantation replaces missing facial structures with anatomically identical tissues, providing desired functional, esthetic, and psychosocial benefits far superior to those of conventional methods. On the basis of very encouraging initial results, it is likely that more procedures will be performed in the near future. Typical candidates have extremely complex vascular anatomy due to severe injury and/or multiple prior reconstructive attempts; thus, each procedure is uniquely determined by the defects and vascular anatomy of the candidate. We detail CT angiography vascular mapping, noting the clinical relevance of the imaging, the angiosome concept and noninvasive delineation of the key vessels, and current controversies related to the vascular anastomoses.
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Affiliation(s)
- S Soga
- Department of Radiology, Applied Imaging Science Laboratory
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[Composite midfacial flap vascularized by the facial artery: a preliminary anatomic study]. ACTA ACUST UNITED AC 2012; 113:155-60. [PMID: 22627055 DOI: 10.1016/j.stomax.2012.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 01/30/2011] [Accepted: 03/01/2012] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Extended facial tissue defects are difficult to reconstruct because of the anatomical and functional complexity of the area. Recently, composite facial allotransplantation was used for reconstruction. This could be performed because of specific facial blood supply and its facial and maxillary anastomoses. Could a composite naso-labio-mental flap rely on the sole blood supply of a facial artery anastomosis? We performed an anatomic study of a naso-labio-mental composite flap vascularized by the facial artery. MATERIAL AND METHOD The study relied on arteriographies made on cadaveric heads and in vivo. The following data was analyzed: caliber of facial and maxillary arteries, terminal branch of facial arteries, and vascular territories. RESULTS Sixteen facial arteries and six maxillary arteries were studied. The mean facial artery caliber was 2.06 mm (1-3.2mm). The facial artery ended in the nasal area in 68.8% of the cases. The latero-nasal artery was always present; it was a branch of the facial artery in 66.7% of cases. The two facial arteries, when injected bilaterally, always allowed complete facial composite flap circulation. The nasal territory of the flap was not opacified by the homolateral facial artery in 16.7% of the cases. DISCUSSION Both facial artery anastomoses are recommended as blood supply for composite midfacial flaps. Preoperative imaging should be used systematically to assess the vascular network before harvesting.
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Nguyen JT, Ashitate Y, Buchanan IA, Ibrahim AMS, Gioux S, Patel PP, Frangioni JV, Lee BT. Face transplant perfusion assessment using near-infrared fluorescence imaging. J Surg Res 2012; 177:e83-8. [PMID: 22572616 DOI: 10.1016/j.jss.2012.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/02/2012] [Accepted: 04/10/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Composite tissue allografts (CTAs) including partial face transplantation have been achieved clinically. However, risks of complications including tissue ischemia, rejection, and transplant failure are significant. Safe and effective techniques to assess perfusion are needed to decrease complications in composite tissue flaps. Near-infrared (NIR) fluorescence imaging has been previously shown to provide a real-time, intraoperative evaluation of perfusion. This study investigates the use of NIR imaging in partial face CTA harvest. METHODS We created hemifacial CTAs (n = 8) using an established porcine model. This included ear cartilage, nerve, lymphoid tissue, muscle, and skin with perfusion by the carotid artery and external jugular vein. We injected animals systemically with indocyanine green and obtained NIR fluorescence images simultaneously with color video. In addition, we assessed the elevated hemifacial flaps using standard of care (i.e., clinical examination and Doppler). RESULTS Flap design was facilitated by NIR imaging with localization of perforators to the hemifacial CTA flap. In particular, an arterial and venous phase could be clearly identified. We assessed perfusion of the flap by NIR fluorescence intensity after injection of indocyanine green. Sequential clamping of the artery and vein confirmed correlation of perfusion deficits with NIR imaging as well as with clinical examination and Doppler. CONCLUSIONS Evaluation and assessment of perfusion are important in facial transplantation. The results from our pilot study indicate that NIR imaging has the capability to assess perfusion of partial facial CTAs. This emergent technology shows promise in assessing tissue perfusion in a composite flap.
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Affiliation(s)
- John T Nguyen
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Craniomaxillofacial reconstruction using allotransplantation and tissue engineering: challenges, opportunities, and potential synergy. Ann Plast Surg 2012; 67:655-61. [PMID: 21825966 DOI: 10.1097/sap.0b013e31822c00e6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The face is composed of an intricate underlying bony/cartilaginous framework that supports muscle, secretory organs, and sophisticated skin/subcutaneous structures. These components are attached through numerous ligaments and interact dynamically with a vast neurovascular network. The most sophisticated autologous reconstructive techniques, utilizing composite free-tissue flaps, are often inadequate to restore extensive maxillofacial defects. Massive craniomaxillofacial (CMF) defects resulting from trauma, oncologic resection, or congenital deformity present a unique challenge to reconstructive surgeons. Therefore, recent advances in craniofacial surgery and immunotherapy spurred the innovation of composite tissue allotransplantation (CTA), which permits reconstruction with tissue composed of all necessary components. However, CMF allotransplantation carries with it side effects of lifelong immunosuppression. Furthermore, the donor skeletal framework may not provide an ideal match, resulting in less than ideal occlusion and soft-tissue anthropometrics. An alternative to transplantation, tissue engineering, has provided hope for regenerating missing tissue and avoiding the need for immunosuppression. Many tissue subtypes, including bone and cartilage, have been successfully created, with sparse reports of clinical application. Tissue-engineered composite tissue required for complete CMF reconstruction continues to elude development, with vascular supply and tissue interactions posing the largest remaining obstacles. We report herein the current status and limitations of CTA and tissue engineering. Furthermore, we describe for the first time our vision of hybridization of CTA and engineering, utilizing the strengths of each strategy.
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Rodriguez-Lorenzo A, Audolfsson T, Rozen S, Kildal M, Nowinski D. Supraorbitary to infraorbitary nerve transfer for restoration of midface sensation in face transplantation: Cadaver feasibility study. Microsurgery 2012; 32:309-13. [DOI: 10.1002/micr.21944] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/04/2011] [Accepted: 11/09/2011] [Indexed: 11/06/2022]
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Pomahac B, Nowinski D, Diaz-Siso JR, Bueno EM, Talbot SG, Sinha I, Westvik TS, Vyas R, Singhal D. Face Transplantation. Curr Probl Surg 2011; 48:293-357. [DOI: 10.1067/j.cpsurg.2011.01.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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The Procurement of Allotransplants for Ballistic Trauma: A Preclinical Study and a Report of Two Clinical Cases. Plast Reconstr Surg 2011; 127:1892-1900. [DOI: 10.1097/prs.0b013e31820e915a] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bueno J, Barret JP, Serracanta J, Arnó A, Collado JM, Valles C, Colominas MJ, Diez Y, Pont T, Salamero P, Martinez-Ibañez V. Logistics and strategy of multiorgan procurement involving total face allograft. Am J Transplant 2011; 11:1091-7. [PMID: 21443675 DOI: 10.1111/j.1600-6143.2011.03489.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The face is the latest body structure to be added to the field of transplantation and the learning curve is ongoing. In the scenario of multiorgan recovery, the face is a nonvital 'organ' structure compared with other life-saving organs. To date, the face has been the first 'organ' to be procured in a multiorgan procurement. A technique for simultaneous recovery of the whole face, heart, lungs, liver, pancreas and kidneys is described. Thirty professionals participated in the procedure, of whom 13 were surgeons. No tracheotomy was performed. A mask of the donor's face was made from a mold impression. Duration of the procedure from skin incision to the end of surgery was 7.3 h. The face was perfused with Wisconsin solution through a cannula inserted into the aortic arch between the origin of the brachiocephalic arterial trunk and the left subclavian artery. Blood requirements consisted of 4 units of packed red blood cells. After the procedure, the mask was placed on the donor's face. All recovered grafts functioned immediately. In summary, simultaneous multiorgan procurement including the whole face is feasible, effective and saves time without jeopardizing life-saving organs and without the need for tracheotomy.
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Affiliation(s)
- J Bueno
- Pediatric Liver Transplantation Unit, Hospital Universitario Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
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