The World's Experience With Facial Transplantation

Abstract

The objective of this review article is to summarize the published details and media citations for all seven face transplants performed to date to point out deficiencies in those reports so as to provide the basis for examining where the field of face transplantation stands, and to act as a stimulus to enhance the quality of future reports and functional outcomes. Overall long-term function of facial alloflaps has been reported satisfactorily in all seven cases. Sensory recovery ranges between 3 and 6 months, and acceptable motor recovery ranges between 9 and 12 months. The risks and benefits of facial composite tissue allotransplantation, which involves mandatory lifelong immunosuppression analogous to kidney transplants, should be deliberated by each institution's multidisciplinary face transplant team. Face transplantation has been shown thus far to be a viable option in some patients suffering severe facial deficits which are not amenable to modern-day reconstructive technique.

Risk assessment and management in hand and facial tissue transplantation

“…The risks of acute rejection in hand and face transplantation are higher than previously estimated (85 vs 10%) [38,39,41]. Rejection presents with cutaneous changes (erythema, edema and maculopapular lesions) that are detected easily and immediately allowing for early intervention (adjustment of immunosuppressive medications) and reversal.…”

“…The real immunologic risks to which CTA recipients are exposed A summary of the risks that have been reported for kidney, hand ([10 years follow-up) [38] and face transplants (seven of the more than 15 performed to date, a few of which are less than 4 years post-transplant) is presented in Table 1 [38][39][40][41].…”

“…Although more than ten face transplants have been performed worldwide, risk data was reviewed in seven recipients reported thus far [39][40][41]. It is important to note that all transplant recipients in these studies received the same immunosuppressive medications (tacrolimus/mycophenolate mofetil/Corticosteroid) as that used currently in hand and face transplant recipients.…”

Supraorbitary to infraorbitary nerve transfer for restoration of midface sensation in face transplantation: Cadaver feasibility study

“…The time of sensory recovery in the first 10 face transplants recipients reconstructed with or without nerve reconstruction has been described by Gordon et al and it ranged between 3 and 6 months. 10 From all the mechanisms of sensory recovery after face transplantation, direct nerve coaptation of sensory nerves is most likely the one to produce the most predictable clinical outcomes. Direct sensory nerve growth through microsurgical repair has proven to provide better sensory recovery in free tissue transfer of sensate flaps used in conventional head and neck reconstruction in comparison with flaps without sensory nerve coaptation.…”

Tunneled superficial inferior epigastric artery (SIEA) myocutaneous/vascularized femur chimeric flaps: A model to study the role of vascularized bone marrow in composite allografts

“…VCAs have been performed on a limited clinical basis with acceptable outcomes using conventional immunosuppression. [18][19][20] These cases have all required immunosuppressive medications that are associated with significant life-long medical risks, which are seen as a major hurdle to widespread adoption of this promising reconstructive option. 2,21 The induction or development of mixed allogeneic chimerism (partial engraftment of donor hematopoietic cells in the recipient) can lead to long-term donor-specific tolerance, thereby reducing the need for immunosuppression.…”