Reconstruction of a Severe Facial Defect by Allotransplantation in Neurofibromatosis Type 1: A Case Report

Sicilia-Castro, Domingo; Gómez-Cía, Tomás; Infante-Cossio, Pedro; Gacto-Sánchez, Purificación; Barrera-Pulido, Fernando; Lagares-Borrego, Araceli; Narros-Gimenez, Rocio; García-Perla, Alberto; Hernández-Guisado, José-María; Gonzalez-Padilla, Juan-David

doi:10.1016/j.transproceed.2011.06.030

Cited by 37 publications

(36 citation statements)

References 12 publications

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“…Twenty days to 1 year after FT, all these patients were capable of oral food intake and gastrostomies were unnecessary (17,21,26,27,33,35). In addition, three patients were reported as able to swallow or capable of autonomous oral feeding, although impairment in feeding was not reported previous to FT (22,29,31).…”

Section: Eatingmentioning

confidence: 97%

“…Most reports stated the beginning of sensory recovery and differentiated between the perception of thermal and mechanical stimuli. Whereas light touch was noticeable 3-12 months after FT (22,27), perception of temperature began after 6-8 months (21,22,31). One patient was only sensible to deep pressure after 17 months and another patient lacked thermal perception 12 months after FT (27).…”

Section: Sensationmentioning

confidence: 98%

“…Sensory recovery was addressed in the peer-reviewed literature for nine FT recipients (21,22,27,(31)(32)(33)35). Data concerning sensation previous to FT were not provided in any case.…”

Section: Sensationmentioning

confidence: 99%

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Functional Outcomes of Face Transplantation

Fischer

Kueckelhaus

Pauzenberger

et al. 2015

American Journal of Transplantation

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In this study we provide a compilation of functional impairments before and improvements after face transplantation (FT) of five FT recipients of our institution and all FTs reported in current literature. Functional outcome included the ability to smell, breath, eat, speak, grimace and facial sensation. Before FT, all our patients revealed compromised ability to breath, eat, speak, grimace and experience facial sensation. The ability to smell was compromised in two of our five patients. Two patients were dependent on tracheostomy and one on gastrostomy tubes. After FT, all abilities were significantly improved and all patients were independent from artificial air airways and feeding tubes. Including data given in current literature about the other 24 FT recipients in the world, the abilities to smell, eat and feel were enhanced in 100% of cases, while the abilities of breathing, speaking and facial expressions were ameliorated in 93%, 71% and 76% of cases, respectively. All patients that required gastrostomy and 91% of patients depending on tracheostomy were decannulated after FT. Unfortunately, outcomes remain unreported in all other cases and therefore we are unable to comment on improvements.

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Section: Eatingmentioning

confidence: 97%

Section: Sensationmentioning

confidence: 98%

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Functional Outcomes of Face Transplantation

Fischer

Kueckelhaus

Pauzenberger

et al. 2015

American Journal of Transplantation

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“…[21] Other teams have performed the anastomosis at peripheral facial nerve branches doing an intra-parotid nerve dissection [45,46] connecting only distal branches to the parotid gland. [1,47] Regarding sensory nerves, most teams connected infraorbital and mental nerves [48][49][50][51] while the supraorbital nerve neurorrhaphy is preferably carried out in full FT. [35,36,52,53] …”

Section: Overall Aspects On Surgerymentioning

confidence: 99%

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

Infante-Cossio¹,

Barrera-Pulido²,

Gómez-Cía³

et al. 2016

PAR

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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.

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“…20 Light touch is generally detectable by the patient 3-12 months following transplant, and temperature after 6-8 months. 16,18,19,21 Interestingly, Siemionow et al reported that only one of 4 patients that she summarized underwent successful anastomosis of both the mental and infraorbital sensory nerves. 22 However, all 4 patients regained full sensation comparable to the patient with successful coaptation.…”

Section: Nerve Injury and Regeneration In Vcamentioning

confidence: 99%

Advances in peripheral nerve regeneration as it relates to VCA

Suchyta

Sabbagh

Morsy

et al. 2016

Vascularized Composite Allotransplantation

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Vascularized composite allotransplant (VCA) offers functional, social, and quality of life improvements for patients who have exhausted traditional reconstructive options. Unlike solid organ transplant, VCA success is not only based upon the quality of perfusion and level of immunosuppression, but also on the success of nerve regeneration within the transplanted part. This paper will summarize the present state of peripheral nerve regeneration in the context of VCA and will explore the latest research advances that will affect the future of the field. These advances offer promising future strategies to improve patient outcomes in VCA.

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Reconstruction of a Severe Facial Defect by Allotransplantation in Neurofibromatosis Type 1: A Case Report

Cited by 37 publications

References 12 publications

Functional Outcomes of Face Transplantation

Functional Outcomes of Face Transplantation

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

Advances in peripheral nerve regeneration as it relates to VCA

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