No abstract

Composite facial allotransplantation is emerging as a treatment option for severe facial disfigurements. The technical feasibility of facial transplantation has been demonstrated, and the initial clinical outcomes have been encouraging. We report an excellent functional and anatomical restoration 1 year after face transplantation. A 59-year-old male with severe disfigurement from electrical burn injury was treated with a facial allograft composed of bone and soft tissues to restore midfacial form and function. An initial potent antirejection treatment was tapered to minimal dose of immunosuppression. There were no surgical complications. The patient demonstrated facial redness during the initial postoperative months. One acute rejection episode was reversed with a brief methylprednisolone bolus treatment. Pathological analysis and the donor's medical history suggested that rosacea transferred from the donor caused the erythema, successfully treated with topical metronidazol. Significant restoration of nasal breathing, speech, feeding, sensation and animation was achieved. The patient was highly satisfied with the esthetic result, and regained much of his capacity for normal social life. Composite facial allotransplantation, along with minimal and well-tolerated immunosuppression, was successfully utilized to restore facial form and function in a patient with severe disfigurement of the midface.

With minor technical modifications, DIEP flaps can be performed successfully without increased flap complications in patients with preexisting abdominal incisions. Despite these design modifications, patients should be informed of an increased risk for donor-site complications.

The internal mammary vessels are frequently used for free flap breast reconstruction and are typically dissected via resection of an entire rib cartilage. Resection of rib cartilage may cause increased postoperative pain or a depressed thoracic contour deformity. We have used a new, less invasive technique that does not resect rib cartilage and exposes the vessels within the rib interspace. Over a 3-year period, all breast free flaps performed with the rib-sparing technique were reviewed and compared with a group of flaps performed with the standard rib resection technique. The rib-sparing technique was performed for 74 flaps, with no significant increase in complications, including revision of anastomosis (3%), fat necrosis (11%), or flap loss (1%), when compared with a group of 125 flaps undergoing rib resection. This less invasive technique is reviewed in detail and may prove beneficial in regard to postoperative pain and incidence of chest wall deformities.