Face transplantation-current status and future developments

Abstract

More than thirty-five facial allograft transplantations (FAT) have been reported worldwide since the pioneering case performed in France in the year 2005. FAT has received tremendous interest by the medical field and the general public while gaining strong support from multiple disciplines as a solution for reconstructing complex facial defects not amenable/responsive to conventional methods. FAT has expanded the frontiers of reconstructive microsurgery, immunology and transplantation, and established its place in the cross section of multiple disciplines. The procedure introduces complex scientific, ethical, and societal issues. Patients and physicians are called to deal with a variety of-sometimes everlasting-challenges, such as immunosuppression management and psychosocial hurdles. This review reflects on the surgical and scientific advancements in FAT and milestones reached in the last 12 years. It aims to encourage active discussion regarding the current practices and techniques used in FAT and suggest future directions that may allow transitioning into the next phase of FAT, which we describe as safe, reliable, and accessible standard operation for selected patients.

Composite tissue allotransplantation: opportunities and challenges

“…Utilizing standard preservation methods, cold ischemic times up to 6 h have been cited as an upper threshold in VCAs. 65,66 Ex vivo perfusion systems, including a hyperbaric, normothermic perfusion system, have recently been explored for VCAs and showed delayed acute rejection processes of VCA. 67…”

“…69 Clinical histological grading for chronic rejection in VCA remains preliminary and does not include vessel vasculopathy, loss of capillaries, or rejection of the oral mucosa. 65,76 An integrative approach involving histological findings and the underlying mechanisms may be helpful in characterizing the conditions. 74 Recurrent and insufficiently treated episodes of acute rejection may also contribute to chronic rejection in both solid organ transplants 77,78 and VCAs.…”

Vascularised Composite Allotransplantation – Basic Science and Clinical Applications

“…A recent review by Pomahac and colleagues (2018) found satisfactory return of sensation at 8 -12 months but that motor recovery lagged behind those initially anticipated for facial transplant [49]. Motor function returned between 6-18 months post operatively with the majority of patients able to breathe, speak, eat and drink after transplantation [5].…”

Innovations in reconstructive microsurgery: Reconstructive transplantation

“…The continuing success in UET led to the introduction of face transplantation (FT) to manage devastating facial injuries that were left unsuccessfully treated by conventional techniques. Currently, there is no clear consensus among reconstructive surgeons on exact patient selection criteria for FT nor the extent of facial allograft, with each VCA center employing institution‐unique protocols . The ASRM/ASPS guiding principles justify FT in patients with severe facial disfigurement, in whom conventional autologous reconstruction has yielded unsatisfactory results .…”

“…Taking into account the variability between the extents of injuries across FT recipients, motor recovery is reported to occur 6‐8 months after the operation on average . Sensation returns earlier than motor function, with reports showing recovery as early as 3 months postoperatively . Although facial nerve coaptation plays a significant role in facial movement rehabilitation, sensation has been shown to return even without sensory nerve coaptation.…”