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

Abstract

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 well-motivated 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.

Keywords

Face transplantation / composite tissue transplantation / facial allograft transplantation / facial reconstruction / outcomes and complications of face transplantation

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