Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment

Abstract

Background: In properly selected patients, combined face and whole eye transplantation (FWET) may offer a more optimal aesthetic and potentially functional outcome while avoiding the complications and stigma of enucleation and prosthetics. This study presents the most comprehensive cadaveric assessment for FWET to date, including rehearsal allograft procurement on a brain-dead donor. Methods: Over a 2-year period, 15 rehearsal dissections were performed on 21 cadavers and one brain-dead donor. After identification of a potential recipient, rehearsals assessed clinical feasibility and enabled operative planning, technical practice, refinement of personalized equipment, and improved communication among team members. Operative techniques are described. Results: Facial allograft procurement closely followed previously described face transplant techniques. Ophthalmic to superficial temporal (O-ST) vessel anastomosis for globe survival was assessed. Craniectomy allowed for maximal optic nerve and ophthalmic vessel pedicle length. Appropriate pedicle length and vessel caliber for O-ST anastomosis was seen. Research procurement demonstrated collateral blood flow to the orbit and surrounding structures from the external carotid system as well as confirmed the feasibility of timely O-ST anastomosis. Personalized cutting guides enabled highly accurate bony inset. Conclusions: This study formalizes an approach to FWET, which is feasible for clinical translation in judiciously selected patients. O-ST anastomosis seems to minimize retinal ischemia time and allow perfusion of the combined allograft on a single external carotid pedicle. Although restoration of vision likely remains out of reach, globe survival is possible.

Whole-eye transplantation: Current challenges and future perspectives

“…Whole-eye transplantation, a pioneering endeavor in medical science, frequently intersects with the intricacies of face transplantation, particularly regarding surgical techniques, tissue integration challenges, and the nuances of immunosuppression[ 23 ]. This confluence is particularly apparent in the comprehensive approach both fields demand, encompassing not just the transplantation of the primary organ but also the intricate reconnection of nerves, blood vessels, and surrounding tissues to reinstate function and achieve aesthetic congruence[ 3 , 24 - 26 ].…”