Enhancing Face Transplant Outcomes: Fundamental Principles of Facial Allograft Revision

Abstract

Background: Facial transplantation (FT) has become a feasible reconstructive solution for patients with devastating facial injuries. Secondary revisions to optimize functional and aesthetic outcomes are to be expected, yet the optimal timing and approach remain to be determined. The purpose of this study was to analyze all facial allograft revisions reported to date, including the senior author’s experience with 3 FTs. Methods: A literature review was performed, with 2 reviewers independently conducting title and abstract screening, followed by a full-text review. All articles mentioning FT revision surgeries were evaluated. The medical records of the senior author’s 3 FT recipients were additionally reviewed. Results: Initially, 721 articles were captured and 37 were included in the final analysis. Thirty-two FTs were reported to have involved posttransplant allograft revisions, with FT recipients undergoing a mean of 4.8 ± 4.6 revision procedures. The mean duration between FT and the first revision procedure was 149 ± 179 days. A wide spectrum of revisions was identified and categorized as involving the soft tissues, craniofacial skeleton, dentition, oronasal cavity, salivary glands, facial nerve, or ocular region. In the senior author’s experience, when indicated, posttransplant occlusal changes and integrity of the donor–recipient intraoral interface were successfully addressed with secondary procedures without allograft compromise or loss. Conclusions: The worldwide experience shows that secondary procedures are nearly ubiquitous after FT and can be safely performed at various timepoints. The authors thereby establish 5 distinct categories of facial allograft revisions and define 7 critical principles to optimize posttransplant procedures.

The 2020 Facial Transplantation Update: A 15-Year Compendium

“…Despite the inherent risks of additional surgeries related to immunosuppression, potential vascular compromise, and triggering of AR, secondary allograft procedures are nearly ubiquitous and can be successfully performed at various timepoints in the posttransplant course. 2 , 14 , 51 The range of indications is wide, including emergent return to the operating room, elective aesthetic surgery, unplanned functional corrections, and end-stage salvage procedures. 2 Overall, facial allograft revisions allow optimization of functional and aesthetic outcomes after FT (Table 5 ).…”

“… 2 , 14 , 51 The range of indications is wide, including emergent return to the operating room, elective aesthetic surgery, unplanned functional corrections, and end-stage salvage procedures. 2 Overall, facial allograft revisions allow optimization of functional and aesthetic outcomes after FT (Table 5 ).…”

Effect of Immunosuppression on the Hybrid Skeleton of Vascularized Composite Allotransplants?

“…Diep et al reviewed the literature for all described facial allograft revisions. 2 They found revisions of the craniofacial skeleton in 15 (35%) of 43 face transplants as of August 2020. 2 Most revisions were performed in the first 6 months following transplantation.…”

“…2 They found revisions of the craniofacial skeleton in 15 (35%) of 43 face transplants as of August 2020. 2 Most revisions were performed in the first 6 months following transplantation. 2 Nevertheless, bone density and strength were not analyzed.…”

“…2 Most revisions were performed in the first 6 months following transplantation. 2 Nevertheless, bone density and strength were not analyzed. 2…”