Special Considerations in Face Transplantation: A Systematic Review

Abstract

: Vascularized composite allotransplantation of the face is an exceedingly complex procedure, requiring extensive planning and surgical precision in order to successfully manage patients with facial disfigurements. This review aims to present an overview of the salient anatomic considerations in facial transplantation, as well as give attention to unique patient populations and special considerations. A literature review was performed in search of articles pertaining to considerations in facial transplantation using the databases PubMed, Web of Science, and Cochrane. Articles selected for further review included full-text articles with an emphasis on specific anatomic defects and how they were addressed in the transplant process, as well as management of special patient populations undergoing facial transplantation. In total, 19 articles were deemed appropriate for inclusion. The use of computer-assisted technologies for the planning portion of the procedure, as well as intraoperative efficiency, has yielded favorable results and can be considered as part of the operative plan. The ultimate outcome is dependent upon the synchronization of subunits of the allograft and the desired functional outcomes, including osseous, ocular, oral, and otologic considerations. Management of specific pathology and subgroups of patients are critical aspects. Although pediatric face transplantation has not yet been performed, it is a likely a future step in the evolution of this procedure. When performing a face transplantation, many components must be considered pre-, intra-, and post-operatively. This systematic review presents specific anatomic considerations, as well as information about special patient populations within this crosssection of multidisciplinary microsurgery, psychiatry, and transplant immunology.

When a Good Flap Turns Bad: A Temporal Predictive Model for Free Flap Complications

“…As microsurgery advances rapidly in its prevalence, diversity of technique, and number of applications, the need for optimizing postoperative care becomes increasingly critical in this field. [23][24][25][26][27][28] This is the first study that assesses the temporal relationships between postoperative complications in microsurgical cases and subsequent complications, which may assist patient counseling, inform enhanced recovery after surgery protocol development, and represent a promising contribution to the effort in minimizing adverse outcomes in microsurgery. In the final cohort, outpatient procedures comprised a nontrivial proportion (5.8%) of all microsurgical cases, the majority of which were related to breast; this finding may reflect growth of outpatient microsurgical breast procedures, which have been claimed to be relatively safe and effective, in the last several years.…”