Achievements and Challenges in Facial Transplantation

Abstract

: The first facial transplantation in 2005 ushered in a new era in reconstructive surgery, offering new possibilities for the repair of severe disfigurements previously limited by conventional techniques. Advances in allograft design, computerized preoperative planning, surgical technique, and postoperative revisions have helped push the boundaries in this new frontier of vascularized composite allotransplantation. Over the past 12 years, 40 of these procedures have been performed across the world, offering the field the opportunity to reflect on current outcomes. Successes achieved in the brief history of facial transplantation have resulted in a new set of obstacles the field must now overcome. In this review, we aim to highlight the achievements, major challenges, and future directions of this rapidly evolving field.

Otologic considerations in a full face transplant recipient

“…Of the at least 40 face transplants performed to date, four have included the ears; however, only the senior author's ( e.d.r. ) 2015 report detailed the surgical approach (Table ) . An additional ear‐containing allograft was reported in 2003, when a team from China transplanted a scalp and bilateral ears to a 72‐year‐old woman following melanoma resection .…”

“…2015 report detailed the surgical approach (Table I). 6,11 An additional ear-containing allograft was reported in 2003, when a team from China transplanted a scalp and bilateral ears to a 72-year-old woman following melanoma resection. 13 However, the case was met with significant criticism due to numerous unanswered questions about its potential contraindications.…”

“…Facial transplantation is a form of vascularized composite allotransplantation (VCA) that offers a functional and aesthetic solution to individuals with severe disfigurement previously unresolved by conventional reconstruction . With over 40 procedures performed to date, facial transplantation continues to challenge surgical norms and has led to the inclusion of larger amounts of soft tissue and skeletal elements than previously thought possible . Given this complexity, a multidisciplinary approach to every facet of patient care is paramount …”

“…5 With over 40 procedures performed to date, facial transplantation continues to challenge surgical norms and has led to the inclusion of larger amounts of soft tissue and skeletal elements than previously thought possible. 6 Given this complexity, a multidisciplinary approach to every facet of patient care is paramount. 7 Previous reports have addressed prosthodontic 8 and oculoplastic considerations in facial transplantation, 9 and although several ear-containing face transplants have been performed, few reports detail the postoperative considerations in otologic care.…”

How to Integrate Lived Experience Into Quality-of-Life Assessment in Patients Considering Facial Transplantation

“…Although more than 40 FT procedures have been performed worldwide and ethics discourse about FT has evolved beyond the risk-benefit ratio of a procedure that seeks to improve rather than extend life, 3 the field has yet to reach consensus regarding how to best define and assess QoL in FT recipientsincluding how to incorporate the meaning and value of patients' lived experiences of facial disfigurement and FT into assessments-as illustrated by the multitude of QoL measures that FT programs have used to evaluate FT candidates and recipients. 4 The lack of conceptual clarity about QoL also applies to other forms of vascularized composite allotransplantation (VCA), including upper extremity, penile, and uterine transplantation.…”