Current role in facial allograft transplantation: what have we learned?

Abstract

Face transplant (FT) has evolved enormously in the last 10 years since the successful completion of the first facial transplant. This procedure has become a new reconstructive option for complex facial deformities to restore the anatomy of patients with severely disfigured faces. The authors review the literature and discuss the main surgical, immunological, and ethical aspects as well as the results described in patients undergoing FT. To date there have been more than thirty FT worldwide. The main indication was post-traumatic deformity. In all cases a standard immunosuppression was performed with three drugs, although acute rejection episodes were observed, that could be controlled with conventional immunosuppressive regimen. Overall, functional and aesthetic results have been excellent at short-term and high satisfaction rate exceeded initial expectations, although long-term data are still scarce. Major complications were opportunistic infections. Five deaths that occurred have reopened the ethical debate about the potential complications and concerns of providing informed consent to recipients. Continuous progresses in microsurgical techniques and preoperative planning have promoted the evolution from partial to full FT. All these are on the basis of accurate and careful selection of wellmotivated candidates. The next challenge will be getting new immunosuppressive treatment strategies. Although clinical experience has demonstrated the FT viability, it is still considered an experimental procedure in which we have much to learn to define its true role in the current reconstructive surgery and resolve major technical, medical and ethical problems involved.

Face transplantation for massive mandibular defects: considerations for allograft design and surgical planning

“…Face transplantation offers significant aesthetic and functional improvements for patients with devastating injuries that cannot be managed with conventional reconstruction [1][2][3] . Including the first procedure performed in 2005, 44 face transplantations have been reported in the scientific literature to date [2,4] .…”

“…Including the first procedure performed in 2005, 44 face transplantations have been reported in the scientific literature to date [2,4] . Successful transplantations have demonstrated the feasibility of this procedure and paved the way for technique refinement and increased operative complexity [3,4] . Surgeons are now able to include vascularized bone in addition to soft tissue in facial allografts [4,5] .…”