Facial Transplantation: An Anatomic and Surgical Analysis of the Periorbital Functional Unit

Vasilic, Dalibor; Barker, John H.; Blagg, Ross; Whitaker, Iain S.; Kon, Moshe; Gossman, M. Douglas

doi:10.1097/prs.0b013e3181c2a5cc

Cited by 18 publications

(10 citation statements)

References 37 publications

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“…None of the dissected cadavers had a history of head or neck trauma, facial surgery, facial deformity, or congenital malformation. Periorbital subunit harvest, as previously described, 3 , 6 , 7 , 9 , 10 was based on a bipedicle vascular supply via the facial vessels and superficial temporal vessels.…”

Section: Resultsmentioning

confidence: 99%

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Optimizing Reconstruction with Periorbital Transplantation

Sosin

Mundinger

Dorafshar

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Section: Resultsmentioning

confidence: 99%

“…2 , 3 Consequently, a paradigm shift in the attitudes toward facial VCA 5 has prompted reconstructive surgeons to consider transplanting isolated periorbital tissues. 6 , 7 …”

mentioning

confidence: 99%

Optimizing Reconstruction with Periorbital Transplantation

Sosin

Mundinger

Dorafshar

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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“…Overall, given the significant progress that has been made in the last decade toward minimization of long-term immunosuppression and tolerance induction wider application of innovative reconstructive options such as facial unit or nasal transplantation can now be realized for patients not amenable to conventional methods of repair. Indeed, anatomical studies for periorbital, 7,8,30 eyelid, 9 and ear units 31 have been reported, although no clinical cases have been published.…”

Section: Discussionmentioning

confidence: 99%

Nasal Unit Transplantation: A Cadaveric Anatomical Feasibility Study

Dorafshar

Mundinger

Robinson

et al. 2016

J reconstr Microsurg

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The science and technical acumen in the field of vascularized composite allotransplantation has progressed rapidly over the past 15 years, and transplantation of specialized units of the face, such as the nose, appears possible. No study to date has evaluated the technical feasibility of isolated nasal unit transplantation (NUT). In this study, we explore the anatomy and technical specifics of NUT. In this study, four fresh cadaver heads were studied. Bilateral vascular pedicle dissections were performed in each cadaver. The facial artery was cannulated and injected with food dye under physiologic pressure in two cadavers, and with lead oxide mixture in two cadavers to evaluate perfusion territories supplied by each vascular pedicle. The facial artery and vein were found to be adequate pedicles for NUT. Divergent courses of the vein and artery were consistently identified, which made for a bulky pedicle with necessary inclusion of large amounts of subcutaneous tissue. In all cases, the artery remained superficial, while the vein coursed in a deeper plane, and demonstrated consistent anastomoses with the superior transverse orbital arcade. While zinc oxide injection of the facial artery demonstrated filling of the nasal vasculature across the midline, dye perfusion studies suggested that unilateral arterial inflow may be insufficient to perfuse contralateral NUT components. Discrepancies in these two studies underscore the limitations of nondynamic assessment of nutritive perfusion. NUT based on the facial artery and facial vein is technically feasible. Angiosome evaluation suggests that bilateral pedicle anastomoses may be required to ensure optimal perfusion.

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“…In cases of transplantation of the upper third of the face or for transplantation of a functional subunit eyelid flap, the superficial temporal artery may be able to be used. 32 The venous outflow would be via the corresponding facial, transverse facial, or superficial temporal veins. While a single arterial and venous anastomosis would likely be sufficient, more than one may be done depending on the size of the facial allograft and the observed flow and perfusion via a single set of vessels.…”

Section: Facial Allotransplantationmentioning

confidence: 99%

Facial transplantation: a review of ethics, progress, and future targets

Edwards¹,

Mathes²

2011

TRRM

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The surgical history of transplantation in the modern era begins in 1956 with the successful transplantation of a kidney between identical twins. Since then the field of transplantation has seen remarkable advancements in both surgical techniques and our understanding and ability to manipulate the immune response. Composite tissue allotransplantation involves the transplantation of any combination of vascularized skin, subcutaneous tissue, blood vessels, nerves, muscle, and bone. Orthotopic hand transplantation is considered the first clinical example of CTA and has seen success at many different centers worldwide. Facial allotransplantation is a recent development in the field of CTA and the first successful case was performed as recently as November 2005. Since then there have been a number of successful facial transplants. The purpose of this paper is to examine some of the issues surrounding facial transplantation including the complex ethical issues, the surgical and clinical issues, cost and administrative issues, and future directions for this new, exciting, and controversial field.

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Facial Transplantation: An Anatomic and Surgical Analysis of the Periorbital Functional Unit

Cited by 18 publications

References 37 publications

Optimizing Reconstruction with Periorbital Transplantation

Optimizing Reconstruction with Periorbital Transplantation

Nasal Unit Transplantation: A Cadaveric Anatomical Feasibility Study

Facial transplantation: a review of ethics, progress, and future targets

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