Patient Expectations in Facial Transplantation

The goal of facial transplantation is to transform severely deformed features in a single, complex operation. Although nearly 20 have been completed since 2005, there is limited information about the subsequent psychosocial status of recipients. The purpose of this study is to describe such changes as captured on a variety of psychosocial measures three and six months after full facial transplantation among three adults who all completed a comprehensive psychiatric assessment before the procedure. We hypothesized and found that participants experienced significant improvement on quality of life measures of physical and mental health based on the MOS-SF-12. While the recipients experienced a decline in their physical quality of life in the three months immediately after surgery, they had improvement by six months (p=.02). Overall mental health showed steady improvement from the time before surgery to six months later (p=.04). These changes, however, were not reflected in another popular measure of quality of life, the EQ-5D. There were no changes in participants’ self-esteem or dyadic function over the same period of time. As facial transplantation evolves from being a novel surgical procedure to an increasingly common clinical practice, future efforts to delineate the psychosocial changes experienced by recipients might include mixed methods analyses, with both qualitative and quantitative data, as well as collaborative assessment protocols shared among facial transplantation programs.

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“…2 Hence there is an expectation that facial transplantation will result in improved quality of life among its recipients. 3, 4 …”

Section: Introductionmentioning

confidence: 99%

Psychosocial Changes 6 Months after Face Transplantation

Chang

Pomahac

2013

Psychosomatics

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“…Simultaneous to this retrieval of the donor tissue, the recipient is prepared by contouring facial tissue remnants and isolating bilateral motor and sensory nerve branches, which can often be complicated by prior trauma and/or surgeries (Pomahac et al , ). Functioning segments of the recipient's facial anatomy are preserved as an ‘exit strategy’ in case of graft failure, which remains an unknown but potentially very serious risk of FT (Vasilic et al , ; Barker et al , ; Pomahac et al , ). At BWH, a sentinel flap is also prepared (as described above).…”

Section: Overview Of Face Transplantationmentioning

confidence: 99%

Intraoral features and considerations in face transplantation

et al. 2015

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Face transplantation (FT) is a unique and novel addition to the field of reconstructive surgery, which offers new hope to facially disfigured individuals. This review provides an overview of FT, including clinical indications, immunological principles, and functional outcomes, as well as an in‐depth characterization of the intraoral hard and soft tissue findings in the six patients transplanted to date at Brigham and Women's Hospital in Boston, MA, USA. Six FT recipients underwent comprehensive clinical and radiographic evaluation to assess their intraoral status, function, and overall health. The extra‐ and intraoral soft tissue was assessed via quantitative sensory testing. The vitality of the transplanted dental hard tissue was evaluated with clinically available testing methods. Native teeth and prostheses were also assessed. Sensation of transplanted oral mucosa varied based on time elapsed from FT, ranging from minimal at 3 months post‐FT, to nearly complete recovery by approximately 24 months. There was mixed success with the integration of donor teeth (Patients 1, 4 and 6), including associated occlusal discrepancies. Mucosal complications included constriction at the donor/recipient interface (Patients 2 and 5) and solitary episodes of mucosal rejection presenting as lichenoid inflammation (Patients 2 and 4). Face transplantation represents a pivotal moment in the history of reconstructive surgery and transplant medicine, providing new optimism to patients with gross facial deformities. This report highlights the successes of FT, but also the challenges of transplanting hard and soft tissues to restore complex stomatognathic function. Further attention directed toward comprehensive oral rehabilitation in FT will contribute to improved outcomes, with the ultimate goal of restoring and optimizing patient quality of life.

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“…This may be related to the experiences of plastic surgeons working with patients undergoing facial cosmetic surgery where it is common to attempt to deflate high expectations. 63,64 The Use of Autologous Tissues Potential recipients of face transplants would be expected to have highly complex wounds involving multiple tissue types. Head and neck surgeons commonly reconstruct portions of the face, but they have not solved the problems of reconstruction of a large disfiguring wound that includes multiple subunits and tissue types.…”

Section: Facial Transplantation As a Cosmetic Proceduresmentioning

confidence: 99%

“…[67][68][69][70] Though graft rejection is likely to be a major disappointment, recipients of face transplants were severely disfigured before their transplantation and did not feel that they would be worse off than they were before the transplantation. 1,5,63,64 Because creation of the recipient site involves excision of tissues, loss of the transplanted segment could leave a larger deficit than was initially present; the options presented to patients have included a second transplant or reconstruction with autologous tissues. The latter would, again, provide a suboptimal esthetic result but may be in line with the patient's evolving goals.…”

Section: Risk Of Graft Failure and Its Potential Impact On The Patientmentioning

confidence: 99%

Supporting Facial Transplantation with the Pillars of Bioethics

Kalliainen

2010

J reconstr Microsurg

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Facial transplantation has recently been offered to patients with severely disfigured faces not amenable to functional reconstruction with autologous tissues. Arguments against this procedure include risks of immunosuppression, the concern that it will be done for cosmesis, the belief that acceptable reconstruction can be achieved with autologous tissues, the potential impact on the patient of graft failure, and the concern that the procedure may be adopted by unqualified centers. If we look to bioethics to help us dissect the question of whether or not facial transplantation should be performed, we see that the majority of the arguments have been proscriptive rather than prescriptive. There are valid arguments in favor of facial transplantation based on the prescriptive pillars of bioethics: autonomy, justice, and beneficence. This article attempts to reframe the dialogue in a prescriptive manner.

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Patient Expectations in Facial Transplantation

Cited by 17 publications

References 14 publications

Psychosocial Changes 6 Months after Face Transplantation

Psychosocial Changes 6 Months after Face Transplantation

Intraoral features and considerations in face transplantation

Supporting Facial Transplantation with the Pillars of Bioethics

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