Face Transplant: Indications, Outcomes, and Ethical Issues—Where Do We Stand?

Abstract

Background: The addition of face allotransplantation (FT) to the head and neck reconstructive surgery arsenal has started a true revolution. This study is aimed at providing an extensive analysis of the current practice of composite tissue allotransplantation. Moreover, a thorough description of pre-procedural, intra-operative, and post-procedural settings, indications, contraindications, outcomes, ethical considerations, and future perspectives is provided. Methods: The authors’ experience was supplemented with a literature review performed by using the PubMed, MEDLINE, and Embase databases on February 21, 2022. The search terms used were “face transplantation indications”, “face transplantation complications”, and “face transplantation ethical issues”. Results: The most recent achievements and long-term clinical sequelae of FT are classified and summarized. A large number of records (4435) were identified. Seventy-five articles were assessed for eligibility. Publications without new data and reports with a patient follow-up < 5 years were excluded. Nineteen articles met the criteria for inclusion. Conclusions: The most recent achievements in the field of FT may be combined with cutting-edge regenerative medicine procedures and innovative immunological processing. It is paramount to build strong international networks between the world FT experts in order to achieve higher-level outcomes and reduce the complication rate. Nevertheless, the utmost caution is required in patient selection, clinical assessment, strict follow-up, and rejection management.

Nanofat in Plastic Reconstructive, Regenerative, and Aesthetic Surgery: A Review of Advancements in Face-Focused Applications

“…ASCs can form capillary-like tubes, increase endothelial cell growth, and reduce endothelial cell apoptosis through secretion of VEGF, HGF, and TGF-β. The expression of FGF and VEGF can stimulate ASC proliferation, migration, attachment, and endothelial differentiation, and can have a co-stimulatory effect on ASC endotheliogenesis [ 26 , 39 , 40 , 41 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ].…”

Incorporating Trauma-informed Approaches to Care in Vascularized Composite Allotransplantation

“…Many recipients of face transplantation report feeling stigmatized, losing self-esteem, and experiencing social exclusion or withdrawal as a result, which has been found to exacerbate depression, anxiety, and suicidality and lead to medication nonadherence. 4 , 21 , 23 , 24 In fact, the visibility of some of these injuries often serves as a reminder to victims of their trauma and is attributed to the development of PTSD. 21 Despite the importance of encompassing all aspects of care in VCA, trauma-informed approaches to patient counseling and support after surgery has received little focus in the surgical literature and warrants further discussion to create the infrastructure and resources to better address the psychosocial well-being of VCA recipients and ensure optimal surgical outcomes.…”

“…First successfully performed in 1998, 1 VCA has demonstrated the ability to restore form and function for individuals who have experienced serious physical trauma such as burns, self-inflicted gunshot wounds, motor vehicle accidents, animal attacks, or other injuries resulting in profound adverse impact on their quality of life. [1][2][3][4] Moreover, the volume of traumatic injuries for which VCA may be a feasible therapeutic option has increased exponentially due to injuries sustained during military conflicts in Iraq and Afghanistan beginning in 2004, many of which were caused by improvised explosive devices. 5 Of the 30,000 U. S. military members injured by improvised explosive devices, approximately 4000 had facial injuries and 500 resulted in limb amputation.…”

International consensus recommendations on face transplantation: A 2-step Delphi study

“…Over the last 17 years, 48 procedures have been performed worldwide. 3 FT is a complex procedure bearing significant risks of complications and mortality, requiring life-long care, and posing major psychosocial challenges. 4 The paucity of cases, the heterogeneity of candidates and contexts, and communication gaps among teams have hampered the development of standardized processes for candidate selection, indications and outcome evaluation, and reporting.…”