First Russian Experience of Composite Facial Tissue Allotransplantation

Abstract

The facial allotransplantation technique was first introduced to the general public in 2005. The definition of the face as a complex system of organs that perform social functions made possible the adaptation of this operation into clinical practice. The year 2010 was the starting point for initial research in the Russian Federation. Based on previous achievements and existing world experience in this field, facial allotransplantation was used for the first time in 2015 in St. Petersburg. The goal of this operation was to reconstruct a soldier’s central facial area after an electric burn; he was injured in the military line of duty. This article describes complications faced regarding the preparation for this operation, the issues encountered for facial tissue removal, as well as donor selection criteria. Each stage of the composite facial allotransplantation, complications that can occur during operation, milestone results, as well as the subsequent rehabilitation and immunosuppressive therapy during the 4-year patient observation period following surgery, including the description of a single episode of cell-humoral rejection of transplanted tissue, are described in detail. The experience gained from the first facial allotransplantation performed in Russia shows the possibility of using a new composite allograft to correct deformities in the central area of the face with the achievement of a successfully functioning and aesthetically pleasing result after the operation. After 4 years of dynamic observation and individual rehabilitation programs, the main goal of the facial transplantation, that is, social re-adaptation of the patient, was achieved.

Long-term Outcomes After Facial Allotransplantation: Systematic Review of the Literature

“…A 4-year outcome report has been published after the completion of this study's literature review, describing a successful social rehabilitation of the patient. 85 Interestingly, a not negligible number of the information could only be found in media or conference outlets, hence limiting the data quality and the comparison with the 23 patients included in the present systematic review. This shows a relevant underreporting of outcomes in the scientific literature, which limits the generalizability of conclusions.…”

Enhancing Face Transplant Outcomes: Fundamental Principles of Facial Allograft Revision

“…Revisions for vascular complications, such as thrombosis or hematoma, debridement of tissue necrosis, and drainage of abscesses, have frequently been described. 25 , 33 , 54 Furthermore, at least 3 cases of chronic rejection requiring allograft removal with free flap reconstruction have been documented in the literature, while 1 case involving retransplantation was reported in the media. 55 – 58 These complications should serve as a reminder that despite best efforts to plan FT and subsequent revisions, vigilance is warranted for unexpected outcomes, including possible allograft loss requiring retransplantation, the ultimate secondary revision.…”

Anesthetic Considerations in Facial Transplantation: Experience at NYU Langone Health and Systematic Review

“…Facial allograft procurement time (range, 4.3–13.3 hours for partial, 4–12 hours for full facial allografts) depends on the recipient defect and efforts to decrease ischemia. 1 , 16 , 25 , 33 , 34 , 44 , 45 , 54 , 65 , 67 , 75 Maintenance of hemodynamic stability and euvolemia in solid organ and facial allograft procurement is particularly challenging. Despite efforts to ensure meticulous hemostasis, donor coagulopathy is not uncommon.…”

“… 5 , 17 , 19 , 101 Decannulation has been reported to occur between 1 week and 1 month posttransplant, with almost all tracheostomies closed by the first year posttransplant. 36 , 37 , 49 , 54 , 57 , 58 , 60 , 65 Enteral feeding is typically initiated after bowel sounds have resumed with subsequent oral diet advancement as tolerated, and cessation of enteral access by 12 months in most reported cases. 17 , 49 , 56 , 58 , 60 …”

“…For example, corticosteroids alone or with antithymocyte globulin have been given before reperfusion of the facial allograft. 1 , 32 , 34 , 38 , 54 , 76 The complete induction regimen has also been administered at incision time. 36 Antimicrobial prophylaxis covering bacterial, viral, and fungal infections is particularly important in the early postoperative period when the highest incidence of infection occurs.…”