Restoration of the Donor after Face Graft Procurement for Allotransplantation: Report on the Technique and Outcomes of Seven Cases
Department of Plastic and Reconstructive Surgery, Henri Mondor Hospital, and the XII Medical School, Université Paris-Est Créteil, Créteil, France. Plastic and Reconstructive Surgery
(Impact Factor: 2.99).
05/2012; 129(5):1105-11. DOI: 10.1097/PRS.0b013e31824a2bf8
After organ retrieval, restoration of the donor is a legal and ethical necessity; this is particularly true in facial transplantation. However, very few data are available regarding this procedure.
This article reviews the seven facial masks produced during seven consecutive face transplants carried out at Henri Mondor Hospital in Paris, France. The time of production, morphologic outcome, and donor family feedback were recorded. Technical tips and pitfalls are also discussed.
Recording an impression of the donor's face with alginate required less than 25 minutes and, in all cases, the production of a resin mask was completed before the surgical harvesting was finished. Although all morphologic results were satisfactory or very satisfactory, the best outcomes were achieved using a total face mask, avoiding color discrepancies. Family feedback was positive, and none of the funeral ceremonies was disturbed by the procedure.
The production of a full-face resin mask is a reliable and reproducible technique. This procedure restores donor integrity and gives a very satisfactory morphologic and aesthetic outcome.
Available from: PubMed Central
- "Given the breadth of the field, plastic surgeons have not surprisingly always been at the forefront in pioneering and discovering new techniques and developing innovations that have had a profound impact on mankind as a whole.8–11 The fields of cardiovascular, vascular, and transplant surgery were made possible by Joseph Murray who was awarded the Nobel prize in medicine for his efforts and contributions, not dissimilar to the advent of composite tissue allotransplantation also cultivated by our field.12,13 Clearly, the life of a plastic surgeon will be one of lifelong training, exploration, and personal development. "
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Microvascular reconstruction for oncologic defects is a challenging and rewarding endeavor, and successful outcomes are dependent on a multitude of factors. This study represents lessons learned from a personal prospective experience with 100 consecutive free flaps.
All patients’ medical records were reviewed for demographics, operative notes, and complications.
Overall 100 flaps were performed in 84 consecutive patients for reconstruction of breast, head and neck, trunk, and extremity defects. Nineteen patients underwent free flap breast reconstruction with 10 patients undergoing bilateral reconstruction and 2 patients receiving a bipedicle flap for reconstruction of a unilateral breast defect. Sixty-five free flaps were performed in 61 patients with 3 patients receiving 2 free flaps for reconstruction of extensive head and neck defects and 1 patient who required a second flap for partial flap loss. Trunk and extremity reconstruction was less common with 2 free flaps performed in each group. Overall, 19 patients (22.6%) developed complications and 14 required a return to the operating room. There were no flap losses in this cohort. Thorough preoperative evaluation and workup, meticulous surgical technique and intraoperative planning, and diligent postoperative monitoring and prompt intervention are critical for flap success.
As a young plastic surgeon embarking in reconstructive plastic surgery at an academic institution, the challenges and dilemmas presented in the first year of practice have been daunting but also represent opportunities for learning and improvement. Skills and knowledge acquired from time, experience, and mentors are invaluable in optimizing outcomes in microvascular free flap reconstruction.
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ABSTRACT: INTRODUCTION:: The central face high-energy avulsive injury has been frequently encountered and predictably managed at the R Adams Cowley Shock Trauma Center. However, despite significant surgical advances and multiple surgical procedures, the ultimate outcome continues to reveal an inanimate, insensate and sub-optimal aesthetic result. METHODS:: To effectively address this challenging deformity, a comprehensive multidisciplinary approach was devised. The strategy involved the foundation of a basic science laboratory; the cultivation of a supportive institutional clinical environment; the innovative application of technologies; cadaveric simulations; a real-time clinical rehearsal; and an informed and willing recipient who had the characteristic deformity. RESULTS:: Following Institutional Review Board and organ procurement organization approval, a total face, double jaw and tongue transplantation was performed on a 37-year-old male with a central face high-energy avulsive ballistic injury. CONCLUSION:: This facial transplant represents the most comprehensive transplant performed to date. Through a systematic approach and clinical adherence to fundamental principles of aesthetic, craniofacial, and microsurgery as well as the innovative application of technologies, restoration of human appearance and function for individuals with a devastating composite disfigurement is now a reality.
Available from: David Leonard
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ABSTRACT: Concomitant vascularized composite tissue allotransplantation (VCA) offers single stage restoration of complex anatomical units in a manner that would be dif-ficult, if not impossible to accomplish using conventional reconstructive techniques. However, such extensive and complex transplant procedures have considerable inherent risk. Two cases of concomitant face and hand transplan-tation have been performed to date, both with significant early complications leading to significant morbidity, and in one case, mortality. These cases highlight some of the unknowns in both perioperative and immunological man-agement that must be addressed if this complex subset of VCA procedures is to be more widely offered. Only once these acute challenges can be reliably managed will focus turn to rehabilitation and long-term outcomes. If these issues can be overcome, concomitant face and upper extremity transplantation could offer patients who have suffered severe, complex injuries unprecedented options for restoration of function and form.
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