Autologous Reconstruction of a Face Transplant Candidate

Abstract

Since 2005, facial transplantation has emerged as a viable reconstructive option for the most severe defects not amenable to conventional reconstructive techniques, with promising aesthetic and functional outcomes to date. Key facial subunits and midface structures such as the eyelids, lips, and nose are now able to be successfully replaced rather than reconstructed, enabling adequate functional outcomes in even the most extensive defects. However, even in cases of severe facial disfigurement, the decision to proceed with transplantation versus autologous reconstruction remains a source of debate, with no current consensus regarding precise indications and inclusion/exclusion criteria. This report details the case of a candidate referred for face transplantation who ultimately underwent autologous facial reconstruction. Through this representative case, our objective is to clarify the criteria that make a patient a suitable face transplant candidate, as well as to demonstrate the outcomes achievable with a conventional autologous reconstruction, using a methodically planned, multistaged approach.

Recipient Selection Criteria for Facial Transplantation

“…Such variable dissemination underscores the difficulty of understanding a program's recipient selection criteria without a consistent location to access this information. Furthermore, only a few FT programs displayed recipient selection criteria on patient-facing websites, which may pose a barrier in the referral process for patients and their physicians 82 . A comprehensive study of the patient referral process found that most self-referrals resulted in immediate exclusion and only 1 of every 6 physician-referred candidates ultimately underwent transplantation 55 .…”

Policies and Price Tags: The Public’s Perception of Face Transplantation and Its Funding

“…27 Significant tissue loss to the majority of the face is a strong indication for FVCA, as autologous reconstruction would not be as feasible given the lack of viable tissue in the face. 27 From a psychosocial standpoint, strong support systems and a lack of active psychiatric issues are further indications for the procedure. 27 Further contributing to donor scarcity is the fact that faces are not listed as a donation option in organ transplant registries.…”

“…27 From a psychosocial standpoint, strong support systems and a lack of active psychiatric issues are further indications for the procedure. 27 Further contributing to donor scarcity is the fact that faces are not listed as a donation option in organ transplant registries. Instead, those who wish to donate their face must separately indicate this on their form, as this process requires a separate authorization.…”

“…Limited data exists regarding determining patient eligibility for FVCA and the criteria selection, though Rifkin et al describes criteria to help identify eligible patients based on the experience of an FVCA surgeon. 27 Significant tissue loss to the majority of the face is a strong indication for FVCA, as autologous reconstruction would not be as feasible given the lack of viable tissue in the face. 27 From a psychosocial standpoint, strong support systems and a lack of active psychiatric issues are further indications for the procedure.…”

“…Post-hoc analysis revealed a significant difference in opinions in the improvement of appearance (item 2) and importance of FVCA compared to SOT (item 8) based on respondent age (P < 0.05 for both). Older respondents (55-64) found FVCA to improve patient appearance more than younger respondents (25)(26)(27)(28)(29)(30)(31)(32)(33)(34). However, older respondents (45-74) were less likely than younger to think FVCA was as important as other organ transplants.…”