Quality Improvement in Facial Transplantation: Standard Approach for Novel Procedures

Plastic and Reconstructive Surgery - Global Open

Diaz-Siso

et al. 2019

Self Cite

Background:Face transplant (FT) candidates present with unique anatomic and functional defects unsuitable for autologous reconstruction, making the accurate design and transplantation of patient-specific allografts particularly challenging. In this case series, we present our computerized surgical planning (CSP) protocol for FT.Methods:CSP, computer-aided design and manufacturing, intraoperative navigation, and intraoperative computerized tomography have been successfully incorporated into a comprehensive protocol. Three consecutive FTs were performed. CSP and postoperative results were compared using computerized tomography–derived cephalometric measurements, and the literature was reviewed.Results:Two full and 1 partial FT were successfully performed using the CSP protocol. CSP facilitated the execution of FT with minor angular and translational cephalometric variations on immediate postoperative imaging. Our evolving experience was accompanied by a decreased reliance on cadaveric simulation, from 10 mock transplants and a research procurement before the senior author’s first clinical FT (2012) to 6 mock transplants and no research procurement before the third FT (2018). Operative time was significantly reduced from 36 to 25 hours, as was the need for major orthognathic surgical revision. This reflects the learning curve and variable case complexity, but it is also representative of improved planning and execution, complemented by the systematic incorporation of CSP into FT.Conclusions:A CSP protocol allows for refinement of operative flow, technique, and outcomes in partial and full FT. Standards for functional and esthetic outcomes are bound to evolve with the field’s growth, and computerized planning and execution offer a reproducible approach to FT through objective quality assurance.

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Computerized Approach to Facial Transplantation: Evolution and Application in 3 Consecutive Face Transplants

Ramly

Plastic and Reconstructive Surgery - Global Open

Diaz-Siso

et al. 2019

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“…Simulated exercises allow face transplant teams to familiarize themselves with the procedure and associated logistics, and troubleshoot potential challenges that may arise. 2,27 Cadaveric rehearsals allow surgical refinement through repetition, objective outcomes assessment, and real-time high-fidelity simulation of the planned procedure; expedited allograft procurement; and decreased operative time and the number of required simulated exercises with subsequent transplants. 2,8,15,30,31,[36][37][38][39] This can be further supplemented with research procurements in brain-dead donors.…”

Section: Computerized Surgical Planning and Implementationmentioning

confidence: 99%

Facial Transplantation: Principles and Evolving Concepts

Plastic &Amp; Reconstructive Surgery

Alfonso

Diep

et al. 2021

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Learning Objectives: After studying this article, the participant should be able to: 1. Appreciate the evolution and increasing complexity of transplanted facial allografts over the past two decades. 2. Discuss indications and contraindications for facial transplantation, and donor and recipient selection criteria and considerations. 3. Discuss logistical, immunologic, and cost considerations in facial transplantation, in addition to emerging technologies used. 4. Understand surgical approaches and anatomical and technical nuances of the procedure. 5. Describe aesthetic, functional, and psychosocial outcomes of facial transplantation reported to date. Summary: This CME article highlights principles and evolving concepts in facial transplantation. The field has witnessed significant advances over the past two decades, with more than 40 face transplants reported to date. The procedure now occupies the highest rung on the reconstructive ladder for patients with extensive facial disfigurement who are not amenable to autologous reconstructive approaches, in pursuit of optimal functional and aesthetic outcomes. Indications, contraindications, and donor and recipient considerations for the procedure are discussed. The authors also review logistical, immunologic, and cost considerations of facial transplantation. Surgical approaches to allograft procurement and transplantation, in addition to technical and anatomical nuances of the procedure, are provided. Finally, the authors review aesthetic, functional, and psychosocial outcomes that have been reported to date.

“…1 Extensive preoperative planning can ensure appropriate facial allograft perfusion, successful procurement, and completion of the procedure without compromising solid organ recovery. 1,2 Donor facial artery (FA) and vein are critical for allograft perfusion, and should be thoroughly evaluated prior to transplantation. 3 In this study, we report the first case, to our knowledge, of bilateral facial vein (FV) drainage into the anterior jugular veins (AJV) encountered in a face donor.…”

Section: Unique Venous Anatomy In a Face Donormentioning

confidence: 99%

“…More than 40 procedures have been performed to date . Extensive preoperative planning can ensure appropriate facial allograft perfusion, successful procurement, and completion of the procedure without compromising solid organ recovery . Donor facial artery (FA) and vein are critical for allograft perfusion, and should be thoroughly evaluated prior to transplantation .…”

mentioning

confidence: 99%

Unique Venous Anatomy in a Face Donor

Ceradini

Rodriguez

2019

JAMA Facial Plast Surg

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arch in one-third of cases, with this incidence dropping to approximately 10% further distally. Based on this, techniques such as the Borschel 3 and subzygomatic triangle 2 have been described, with the Borschel technique being a relatively distal harvest.In the present study, 11% of patients had a reduction in muscle bulk that was found on clinical assessment, which was consistent with results of an anatomical study. 5 Atrophy detected on MRI suggested that the superficial masseter was more likely than the deep masseter to be affected with the Borschel method of nerve harvest. Given the low risk of masseteric paralysis associated with the Borschel technique, 3 our experience in the present study shows that there is no need for routine postoperative MRI/EMG tests after this procedure, unless clinical indications are present (eg, reduced masseter bulk) or as part of the preoperative assessment for subsequent temporalis transfers.