Face Transplant Graft Procurement: A Preclinical and Clinical Study

Background: Most articles on face composite tissue allotransplantation have considered ethical and immunologic aspects. Few have dealt with the technical aspects of graft procurement. The authors report the technical difficulties involved in procuring a lower face graft for allotransplantation. Methods: After a preclinical study of 20 fresh cadavers, the authors carried out an allotransplantation of the lower two-thirds of the face on a patient in January of 2007. The graft included all the perioral muscles, the facial nerves (VII, V2, and V3) and, for the first time, the parotid glands. Results: The preclinical study and clinical results confirm that complete revascularization of a graft consisting of the lower two-thirds of the face is possible from a single facial pedicle. All dissections were completed within 3 hours. Graft procurement for the clinical study took 4 hours. The authors harvested the soft tissues of the face en bloc to save time and to prevent tissue injury. They restored the donor's face within approximately 4 hours, using a resin mask colored to resemble the donor's skin tone. All nerves were easily reattached. Voluntary activity was detected on clinical examination 5 months postoperatively, and electromyography confirmed nerve regrowth, with activity predominantly on the left side. The patient requested local anesthesia for biopsies performed in month 4. Conclusions: Partial facial composite tissue allotransplantation of the lower two-thirds of the face is technically feasible, with a good cosmetic and functional outcome in selected clinical cases. Flaps of this type establish vascular and neurologic connections in a reliable manner and can be procured with a rapid, standardized procedure. (Plast. Reconstr. Surg. 122: 1383, 2008.)