Face Transplant: Current Update and First Canadian Experience.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 May 2021
01 May 2021
Historique:
entrez:
23
4
2021
pubmed:
24
4
2021
medline:
15
12
2021
Statut:
ppublish
Résumé
Facial vascularized composite allotransplantation has emerged as a groundbreaking reconstructive solution for patients with severely disfiguring facial injuries. The authors report on the first Canadian face transplant. A 64-year-old man sustained a gunshot wound, which resulted in extensive midface bony and soft-tissue damage involving the lower two-thirds of the face. In May of 2018, he underwent a face transplant consisting of Le Fort III and bilateral sagittal split osteotomies in addition to skin from the lower two-thirds of the face and neck. Virtual surgical planning was used to fabricate osteotomy guides and stereolithographic models. Microsurgical anastomoses of the facial (three branches) and infraorbital nerves were performed bilaterally. At 18-month follow-up, the aesthetic outcome was excellent. Partial restoration of light touch sensation had been observed over the majority of the allograft. Although significantly affected, animation, speech, mastication, and deglutition were continuously improving with intensive therapy. Nevertheless, the patient was now tracheostomy and gastrostomy free. Despite these limitations, he reported a high degree of satisfaction with the procedure and had reintegrated into the community. Four grade I episodes of acute rejection with evidence of endotheliitis were successfully treated. Postoperative complications were mainly infectious, including mucormycosis of the left thigh, treated with surgical resection and antifungal therapy. Undoubtedly, immunosuppression represents the greatest obstacle in the field and limits the indications for facial vascularized composite allotransplantation. Continuous long-term follow-up is mandatory for surveillance of immunosuppression-related complications and functional assessment of the graft.
Identifiants
pubmed: 33890901
doi: 10.1097/PRS.0000000000007890
pii: 00006534-202105000-00026
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1177-1188Commentaires et corrections
Type : ErratumIn
Informations de copyright
Copyright © 2021 by the American Society of Plastic Surgeons.
Déclaration de conflit d'intérêts
Disclosure:The authors have no conflicts of interest to declare. A research grant was donated by Johnson & Johnson.
Références
Devauchelle B, Badet L, Lengelé B, et al. First human face allograft: Early report. Lancet 2006;368:203–209.
Sosin M, Rodriguez ED. The face transplantation update: 2016. Plast Reconstr Surg. 2016;137:1841–1850.
Lantieri L, Grimbert P, Ortonne N, et al. Face transplant: Long-term follow-up and results of a prospective open study. Lancet 2016;388:1398–1407
Razonable RR, Amer H, Mardini S. Application of a new paradigm for cytomegalovirus disease prevention in Mayo Clinic’s first face transplant. Mayo Clin Proc. 2019;94:166–170.
Lassus P, Lindford A, Vuola J, et al. The Helsinki face transplantation: Surgical aspects and 1-year outcome. J Plast Reconstr Aesthet Surg. 2018;71:132–139.
Ramly EP, Kantar RS, Diaz-Siso JR, Alfonso AR, Rodriguez ED. Computerized approach to facial transplantation: Evolution and application in 3 consecutive face transplants. Plast Reconstr Surg Glob Open 2019;7:e2379.
Koenig D. First African American face transplant performed. Available at: https://www.webmd.com/a-to-z-guides/news/20191028/first-african-american-face-transplant-performed . Accessed November 20, 2019.
Cabrera AE, Kimberly LL, Kantar RS, et al. Perceived esthetic outcomes of face transplantation: A survey of the general public. J Craniofac Surg. 2018;29:848–851.
Aduen JF, Sujay B, Dickson RC, et al. Outcomes after liver transplant in patients aged 70 years or older compared with those younger than 60 years. Mayo Clin Proc. 2009;84:973–978.
Dorafshar AH, Bojovic B, Christy MR, et al. Total face, double jaw, and tongue transplantation: An evolutionary concept. Plast Reconstr Surg. 2013;131:241–251.
Roche NA, Vermeersch HF, Stillaert FB, et al. Complex facial reconstruction by vascularized composite allotransplantation: The first Belgian case. J Plast Reconstr Aesthet Surg. 2015;68:362–371.
Lantieri L. Face transplant: A paradigm change in facial reconstruction. J Craniofac Surg. 2012;23:250–253.
Rodríguez-Lorenzo A, Audolfsson T, Wong C, Saiepour D, Nowinski D, Rozen S. Vascular perfusion of the facial skin: Implications in allotransplantation of facial aesthetic subunits. Plast Reconstr Surg. 2016;138:1073–1079.
Van Lierde KM, De Letter M, Vermeersch H, et al. Longitudinal progress of overall intelligibility, voice, resonance, articulation and oromyofunctional behavior during the first 21 months after Belgian facial transplantation. J Commun Disord. 2015;53:42–56.
Maciejewski A, Krakowczyk Ł, Szymczyk C, et al. The first immediate face transplant in the world. Ann Surg. 2016;263:e36–e39.
Aycart MA, Kiwanuka H, Krezdorn N, et al. Quality of life after face transplantation: Outcomes, assessment tools, and future directions. Plast Reconstr Surg. 2017;139:194–203.
Roy SF, Krishnan V, Trinh VQ, et al. Lymphocytic vasculitis associated with mild rejection in a vascularized composite allograft recipient: A clinicopathological study. Transplantation 2020;104:e208–e213.