Full face transplantation raises a new set of ethical concerns and technical difficulties when compared with partial face transplantation. Previously, it was thought that full face allografts must include bilateral superficial temporal and facial arteries, dictating the need for inclusion of donor parotid glands. This would lead to poor aesthetic outcomes and limit facial nerve coaptation to the level of the main trunk, which often results in synkinesias. The authors present a new approach to full facial allograft recovery based on blood supply from facial arteries alone. This approach eliminates the need to include parotid glands, enabling more distal coaptation of facial nerve branches and targeted innervation of effector muscles. The recovery can be reproducibly performed within 4 hours.
Three mock cadaver dissections and three full face transplantations were performed.
Donor facial allografts were dissected in cranio-caudal and lateral-to-medial fashion. Individual facial nerve branches were cut medial to parotid glands and coapted to corresponding recipient nerve branches. With the exception of one parotid gland used to add bulk, parotids were generally not included in the allografts. Relevant sensory nerves were coapted. External carotid arteries were dissected, leaving only bilateral facial arteries as the primary arterial supply. All full facial allografts were well perfused immediately following transplantation and are surviving.
The authors describe a new, simple, and reproducible technique of full facial allograft recovery that allows perfusion using only bilateral facial arteries. Their technique follows critical principles of targeted sensory and motor nerve coaptation.
VIDEO DISCUSSION BY EDUARDO DEJESUS RODRIGUEZ, M.D., D.D.S., IS AVAILABLE ONLINE FOR THIS ARTICLE.
From the Division of Plastic Surgery, Brigham and Women's Hospital and Harvard Medical School, and the Harvard Combined Plastic Surgery Residency Program, Harvard Medical School.
Received for publication February 1, 2012; accepted March 20, 2012.
This article reports partial results of the trial registered under the name “Face Transplantation for Treatment of Severe Deformity,” Clinical Trials.gov identification number NCT01281267 (http://clinicaltrials.gov/ct2/show/NCT01281267).
Disclosure: All work described in this article was supported by a research contract between Brigham and Women's Hospital and the U.S. Department of Defense's Biomedical Translational Initiative (contract no. W911QT-09-C-0216). Drs. Bueno, Diaz-Siso, Pomahac, and Pribaz receive partial or full salary support from this contract. None of the authors has any financial interests or commercial associations that might pose or create a conflict of interest with information presented in this article.
Bohdan Pomahac, M.D.; Division of Plastic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Mass. 02115, firstname.lastname@example.org