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Total Face, Double Jaw, and Tongue Transplant Research Procurement: An Educational Model

Bojovic, Branko M.D.; Dorafshar, Amir H. M.B.Ch.B.; Brown, Emile N. M.D.; Christy, Michael R. M.D.; Borsuk, Daniel E. M.D., M.B.A.; Hui-Chou, Helen G. M.D.; Shaffer, Cynthia K. M.S., M.B.A.; Kelley, T. Nicole M.S., C.R.N.P.; Sauerborn, Paula J. M.A.; Kennedy, Karen R.N.; Hyder, Mary M.D.; Brazio, Philip S. M.D.; Philosophe, Benjamin M.D., Ph.D.; Barth, Rolf N. M.D.; Scalea, Thomas M. M.D.; Bartlett, Stephen T. M.D.; Rodriguez, Eduardo D. M.D., D.D.S.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 824–834
doi: 10.1097/PRS.0b013e318262f29c
Reconstructive: Head and Neck: Original Articles
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Background: Transplantation of a facial vascularized composite allograft is a highly complex procedure that requires meticulous planning and affords little room for error. Although cadaveric dissections are an essential preparatory exercise, they cannot simulate the true clinical experience of facial vascularized composite allograft recovery.

Methods: After obtaining institutional review board approval to perform a facial vascularized composite allograft research procurement, a 66-year-old, brain-dead donor was identified. The family graciously consented to donation of a total face, double jaw, and tongue allograft and multiple solid organs.

Results: A craniofacial computed tomographic angiogram was obtained preoperatively to define the vascular anatomy and facilitate virtual computerized surgical planning. The allograft was procured in 10 hours, with an additional 2 hours required for an open tracheostomy and silicone facial impression. The donor was coagulopathic throughout the recovery, resulting in an estimated blood loss of 1500 ml. Fluorescence angiography confirmed adequate perfusion of the entire allograft based on lingual and facial arterial and external jugular and thyrolinguofacial venous pedicles. The solid organ transplant team initiated abdominal organ isolation while the facial allograft procurement was in progress. After completion of allograft recovery, the kidneys and liver were recovered without complication.

Conclusions: Before conducting a clinical face transplant, adequate preparation is critical to maximize vascularized composite allotransplantation outcomes and preserve solid organ allograft function. As more centers begin to perform facial transplantation, research procurement of a facial vascularized composite allograft offers a unique educational opportunity for the surgical and anesthesia teams, the organ procurement organization, and the institution.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

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Baltimore, Md.

From the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, and the Living Legacy Foundation of Maryland.

Received for publication April 6, 2012; accepted April 12, 2012.

The first two authors contributed equally to this article.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Supplemental digital content is available for this article. A direct URL citation appears in the text; simply type the URL address into any Web browser to access this content. A clickable link to the material is provided in the HTML text of this article on the Journal’s Web site (www.PRSJournal.com).

Eduardo D. Rodriguez, M.D., D.D.S., Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Unit, 22 South Greene Street, Baltimore, Md. 21201, erodriguez@umm.edu

©2012American Society of Plastic Surgeons