Evolution of indications for facial transplantation

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2011-11, Vol.64 (11), p.1410-1416
• Main Authors: Pomahac, B, Diaz-Siso, J.R, Bueno, E.M
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blast Injuries - surgery; Burns - surgery; Composite tissue allotransplantation; Face transplantation; Facial allotransplantation; Facial Injuries - surgery; Facial Transplantation - methods; Female; Humans; Indications for face transplantation; Male; Medical sciences; Middle Aged; Patient Selection; Plastic Surgery; Screening for face transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vascularised Composite allotransplantation; Wounds, Gunshot - surgery
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2011.06.024

Summary Face transplantation has the unique potential to restore facial form and function in patients with severe facial defects. Current indications for face transplantation remain limited by unknown long-term outcomes and the requirements for lifelong immunosuppression and substantial plans for reconstruction in case of failure. We initially obtained Institutional Review Board approval for partial face transplantation in patients with defects comprising 25% of the face and/or loss of one or more major facial features. We launched an outcome-oriented face transplantation study and screened 13 potential patients between February 2008 and January 2011. Experience gained during screening motivated the expansion of indications to include full facial defects and the consideration of patient-specific complex issues on a case-by-case basis. Although our programme focuses on restoring absent or severely compromised motor and sensory functions, we recognise aesthetic appearance as a crucial facial function. Patients are extensively educated on the risks and benefits of facial transplantation and then allowed to play the main role in the decision-making process, as long as no absolute exclusion criteria are present. As we learn more about the long-term outcomes of face transplantation and safe reduction of immunosuppression, face-transplant indications may expand from major unreconstructable defects towards potentially minor defects.