The Helsinki approach to face transplantation

Lindford, Andrew; Mäkisalo, Heikki; Jalanko, Hannu; Lauronen, Jouni; Anttila, Veli-Jukka; Juteau, Susanna; Ämmälä, Antti-Jussi; Eskola, Anna; Saarni, Samuli I.; Isoniemi, Helena; Mäkitie, Antti; Lassus, Patrik

doi:10.1016/j.bjps.2018.08.030

Cited by 35 publications

(53 citation statements)

References 44 publications

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“…Reported trends of operative time, fluid resuscitation, and length of stay are documented in Table 6 and stratified by allograft type and indication for surgery (Table 7 ). 1 , 16 – 18 , 20 , 29 – 43 The evidence synthesized was obtained from prospective case series, representing the best available clinical evidence in the FT literature. Table 8 summarizes the anesthetic considerations in FT based on our institutional experience and supported by representative references from the literature review.…”

Section: Resultsmentioning

confidence: 99%

“…Table 8 summarizes the anesthetic considerations in FT based on our institutional experience and supported by representative references from the literature review. 1 , 2 , 4 , 5 , 11 , 16 – 21 , 24 – 27 , 30 – 40 , 42 , 44 – 92 These are elaborated on in the narrative synthesis summarized in the Discussion section of this article.…”

Section: Resultsmentioning

confidence: 99%

“…The success of facial transplantation (FT) depends on a multidisciplinary approach highlighted by cadaveric rehearsals, research procurements, and extensive clinical preparation. 1 – 5 The anesthesia team plays an integral role in the perioperative and intraoperative management of allograft donors and recipients, comprising up to 12% of total FT costs. 6 , 7 The influence of anesthetic considerations on morbidity and mortality in vascularized composite allotransplantation (VCA) has been highlighted through evaluation of upper extremity transplant anesthetic protocols that reduced perioperative bleeding and shortened hospital stay, as well as lessons learned from challenges of quadruple limb transplantation and combined face and hand transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…Discussion of anesthetic considerations is otherwise scarce in the literature despite the field’s evolution with over 40 FTs performed worldwide. 1 , 12 – 20 The goal of this study was to present an institutional anesthesia protocol and variables for 2 facial allograft donors and recipients, define reported anesthetic considerations in FT, and provide a comprehensive update to inform future directions of the field.…”

Section: Introductionmentioning

confidence: 99%

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

Alfonso

Ramly

Kantar

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Anesthetic considerations are integral to the success of facial transplantation (FT), yet limited evidence exists to guide quality improvement. This study presents an institutional anesthesia protocol, defines reported anesthetic considerations, and provides a comprehensive update to inform future directions of the field. Methods: An institutional “FT Anesthesia Protocol” was developed and applied to 2 face transplants. A systematic review of 3 databases captured FTs in the peer-reviewed literature up to February 2020. Two reviewers independently screened titles and abstracts to include all clinical articles with FT recipient and/or donor-specific preoperative, intraoperative, and relevant postoperative anesthetic variables. Data charting guided a narrative synthesis, and quantitative synthesis reported variables as median (range). Results: Our institutional experience emphasizes the importance of on-site rehearsals, anticipation of patient-specific anesthetic and resuscitative requirements, and long-term pain management. Systematic search identified 1092 unique records, and 129 met inclusion criteria. Reports of 37 FTs in the literature informed the following anesthetic axes: donor pre- and intraoperative management during facial allograft procurement, recipient perioperative care, immunotherapy, antimicrobial prophylaxis, and pain management. Quantitative synthesis of 30 articles showed a median operative time of 18 hours (range, 9–28) and fluid replacement with 13 L (5–18) of crystalloids, 13 units (0–66) of packed red blood cells, 10 units (0–63) of fresh frozen plasma, and 1 unit (0–9) of platelets. Conclusions: Anesthetic considerations in FT span the continuum of care. Future efforts should guide standard reporting to establish evidence-based strategies that promote quality improvement and patient safety.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Alfonso

Ramly

Kantar

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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“…As of 2018, 39 cases of face transplantation have been per-formed [1]. The ethical and immunosuppressant-related issues that were brought up in the early period of vascularized composite tissue allotransplantation (VCA) have been addressed.…”

Section: Introductionmentioning

confidence: 99%

Analysis of factors involved in brain-death donor processing for face transplantation in Korea: How much time is available from brain death to transplantation?

Hong¹,

Chung²,

Ahn³

et al. 2019

Arch Plast Surg

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Background Face transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process. Methods A retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs. Results The patient base (n = 1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (± 15.3). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (± 14 hours 50 minutes) and 22 hours 57 minutes (± 16 hours 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%). Conclusions When face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.

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Speech Characteristics and Oromyofunctional Outcomes in Two Bimaxillary Face Transplantation Patients in Helsinki

et al. 2021

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Objectives/Hypothesis: Facial functional restoration is one of the main goals in face transplantation. We report the oromyofacial function outcomes of two bimaxillary face transplantation (FT) patients in Helsinki.Study design: Outcome Study. Methods: Two male patients, aged 34 and 59, had severe functional facial disabilities following self-inflicted gunshot injuries sustained to their mid and lower faces several years earlier. Both underwent tooth-bearing maxillomandibular face transplantation in 2016 and 2018. We collected data regarding speech, swallowing, sensory recovery, motor recovery, and olfaction prior to transplantation. Patient charts were reviewed from the follow-up period of 4 and 2 years, respectively.Results: Speech intelligibility, acceptability, and articulation continued to improve during follow-up for both patients. Voice quality and resonance were mainly normal at last follow-up. Swallowing improved once lip occlusion was regained, with only minor aspiration evident on videofluorography. Both patients had significant improvement in facial mimic muscle function after FT. The first patient who only had buccal sensory nerves connected has only recovered protective facial sensation, whereas our second patient with buccal, infraorbital, and alveolar nerves connected has almost complete facial two-point discrimination.Conclusion: Both patients have regained satisfactory facial sensory and motor function. Sensory recovery seems to be faster and more precise if multiple sensory nerve coaptations are performed. Swallowing and speech have continued to improve over time although not reaching the level of the normal population. We demonstrate how speech-corrective surgery can safely be performed in a FT patient and can improve speech recovery.

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The Helsinki approach to face transplantation

Cited by 35 publications

References 44 publications

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

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

Analysis of factors involved in brain-death donor processing for face transplantation in Korea: How much time is available from brain death to transplantation?

Speech Characteristics and Oromyofunctional Outcomes in Two Bimaxillary Face Transplantation Patients in Helsinki

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