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Aesthetic and Functional Facial Transplantation: A Classification System and Treatment Algorithm

Mohan, Raja M.D.; Borsuk, Daniel E. M.D.; Dorafshar, Amir H. M.D.; Wang, Howard D. B.A.; Bojovic, Branko M.D.; Christy, Michael R. M.D.; Rodriguez, Eduardo D. M.D., D.D.S.

Plastic & Reconstructive Surgery: February 2014 - Volume 133 - Issue 2 - p 386–397
doi: 10.1097/01.prs.0000437259.24069.35
Reconstructive: Head and Neck: Original Articles

Background: As of July of 2013, 27 facial vascularized composite allotransplantations have been performed. The authors developed a classification system and treatment algorithm that is practical and surgically applicable.

Methods: The majority of the transplants have been described in the surgical literature and the media, and a review of the data was performed. A classification system and a treatment algorithm were designed. Skeletal defects were defined by craniofacial osteotomies and soft-tissue defects by aesthetic facial subunits. The soft-tissue defect was subdivided into the following subunits: oral-nasal (type 1), oronasal-orbital (type 2), and full facial (type 3). The bony defects were subdivided into mandibular involvement (M), Le Fort 1 (A), Le Fort 3 (B), and monobloc (C).

Results: The mechanisms of injury included trauma (n = 13), burns (n = 8), congenital deformity (n = 3), oncologic resection (n = 1), and unreported (n = 2). According to the proposed classification system: one was type 1; one was type 1-M; one was type 1-MB; two were type 2; two were type 2-B; two were type 2-MB; six were type 3; one was type 3-B; and three were type 3-MB; eight could not be classified due to a lack of data. The treatment algorithm designed a vascularized composite allotransplantation that addressed the bony and soft-tissue components.

Conclusions: Patient selection for these complicated procedures, currently dependent on lifelong immunosuppression, is crucial to their success. The authors describe a classification system and treatment algorithm for facial defects that may be ideally suited for facial transplantation. The proposed classification and algorithm may help centers define indications and ideally improve patient outcomes.


Baltimore, Md.

From the Division of Plastic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine.

Received for publication May 24, 2013; accepted August 29, 2013.

Disclosure: The authors have no financial interest in any of the products, devices, or drugs mentioned in this article. Dr. Rodriguez has received grants, payments for lectures, travel accommodations, and expenses for unrelated activities from Synthes CMF. He has also received grants from KLS Martin.

Eduardo D. Rodriguez, M.D., D.D.S., Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, Md. 21201,

©2014American Society of Plastic Surgeons