Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant: A Reconstructive Solution for the Full Face and Total Scalp Burn

Sosin, Michael; Ceradini, Daniel J.; Levine, Jamie P.; Hazen, Alexes; Staffenberg, David A.; Saadeh, Pierre B.; Flores, Roberto L.; Sweeney, Nicole; Bernstein, G. Leslie; Rodriguez, Eduardo D.

doi:10.1097/prs.0000000000002322

Cited by 90 publications

(64 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The technical details of the surgical procedure have been previously described. 3 , 4 , 16 , 25 The patients’ UOPs and MAPs were maintained at goal (Fig. 2 ) with vasopressin 0.02–0.04 units/min and phenylephrine boluses as appropriate.…”

Section: Resultsmentioning

confidence: 99%

“…Both patients received induction and maintenance immunosuppression therapy as previously described. 16 , 25 , 27 Recipient characteristics and pre- and postoperative laboratory values are outlined in Table 4 . Intraoperative MAPs and UOPs are shown in Figure 3 , and the procedure summary and fluid requirements in Table 5 .…”

Section: Resultsmentioning

confidence: 99%

“… 44 Preoperative tracheostomy can be performed at a preliminary stage in anticipation of FT, or as the first step of the procurement procedure. 1 , 17 , 25 , 38 , 44 , 45 Due to previous concerns of tracheostomy potentially interfering with lung procurement, facial allograft procurement with endotracheal intubation has also been described. 46 , 50 , 51 Preoperative CT cerebral angiography, formal angiography, mask production, and placement of radial artery and femoral venous catheters are other essential preparatory steps.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

See 3 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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…1,2 To date, primary applications of VCA have been restricted to upper extremity and face transplants, [3][4][5][6][7] although abdominal wall, lower extremity, scalp, larynx, uterus and penis transplantation have been reported in the literature. [8][9][10][11][12][13] Unlike solid organ transplantations (SOTs), VCAs are not aimed to reduce mortality but to enhance the recipient's quality of life by normalizing appearance and improving psychosocial function. Improvements in physical function may also be possible post-VCA which are typically not observed post-traditional reconstructive procedures, e.g.…”

Section: Introductionmentioning

confidence: 99%

<p>Public attitudes toward vascularized composite allograft donation: a literature review</p>

Kaur¹,

Thoma²

2019

TRRM

View full text Add to dashboard Cite

Vascularized composite allotransplantation (VCA) is the transplantation of anatomical or functional structures composed of multiple types of tissues. The technical advancement of solid organ transplantation and replantation instigated the development of the skills required for successful VCA several years ago; however, the recent advancements in immunosuppression therapy have renewed the interest in this field. As VCAs are primarily life-enhancing procedures, the perception and attitudes of the general public (i.e. potential donors and candidates) and the health care professionals is extremely relevant in terms of health policy and funding decision allocations, availability of donor tissue and ethical and legal implications. In this article, we review the current evidence to assess the sociocultural and demographic factors that influence the growth and success of VCA procedures.

show abstract

Combined Whole Eye and Face Transplant

Ceradini,

Tran,

Dedania

et al. 2024

JAMA

View full text Add to dashboard Cite

ImportanceCatastrophic facial injury with globe loss remains a formidable clinical problem with no previous reports of reconstruction by whole eye or combined whole eye and facial transplant.ObjectiveTo develop a microsurgical strategy for combined whole eye and facial transplant and describe the clinical findings during the first year following transplant.Design, Setting, and ParticipantA 46-year-old man who sustained a high-voltage electrical injury with catastrophic tissue loss to his face and left globe underwent combined whole eye and face transplant using personalized surgical devices and a novel microsurgical strategy at a specialized center for vascularized composite allotransplantation.Main Outcomes and MeasuresReperfusion and viability of the whole eye and facial allografts, retinal function, and incidence of acute rejection.ResultsThe patient underwent a combined whole eye and face transplant from an immunologically compatible donor with primary optic nerve coaptation and conventional postoperative immunosuppression. Globe and retinal perfusion were maintained throughout the immediate postoperative period, evidenced by fluorescein angiography. Optical coherence tomography demonstrated atrophy of inner retinal layers and attenuation and disruption of the ellipsoid zone. Serial electroretinography confirmed retinal responses to light in the transplanted eye. Using structural and functional magnetic resonance imaging, the integrity of the transplanted visual pathways and potential occipital cortical response to light stimulation of the transplanted eye was demonstrated. At 1 year post transplant (postoperative day 366), there was no perception of light in the transplanted eye.Conclusions and RelevanceThis is the first report of whole eye transplant combined with facial transplant, demonstrating allograft survival including rejection-free graft survival and electroretinographic measurements indicating retinal response to light stimuli. These data highlight the potential for clinical allotransplantation for globe loss.

show abstract

Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant: A Reconstructive Solution for the Full Face and Total Scalp Burn

Abstract: Therapeutic, V.

Cited by 90 publications

References 51 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

<p>Public attitudes toward vascularized composite allograft donation: a literature review</p>

Combined Whole Eye and Face Transplant

Contact Info

Product

Resources

About