title: Facial transplantation: a comprehensive review of the literature.
abstract: OBJECTIVE
  Composite tissue allotransplantation has become a clinical reality and a major breakthrough in reconstructive surgery. The current boundary of dispute on composite tissue allotransplantation is regarding the full-face transplantation. The aim of this article is to provide a comprehensive overview of how facial allotransplantation has been approached in the scientific literature.
  
  
  METHODS
  The selection of articles was conducted using PubMed at between January 2000 and September 2005. The search terms were "facial graft," "facial transplantation," and "facial allotransplant." The criteria of analysis were the category of articles and the presence of 6 items: 1) issues regarding the donor; 2) psychological impact on the recipient; 3) surgical risks; 4) immunologic risks; 5) socio-cultural aspects; and 6) expense.
  
  
  RESULTS
  Thirty-eight articles were included. The first article was published in 2002. Most articles over the last 4 years dealt with issues of medical ethics. The annual rate of basic research articles was relatively stable. Conversely, the rate of 'view points,' notably regarding ethics aspects, increased dramatically in 2004. The issues regarding the donor were found in 26% of the articles, the psychological echo on the recipient in 53% of the articles but in 81% of the medical ethics papers, the immunologic risks in 81% of the articles, the surgical risks in 66% of the articles, socio-cultural aspects in 34% of the articles, and expense problems in 5% of the articles.
  
  
  CONCLUSIONS
  Psychological, immunologic, and surgical risks are the problems addressed most in the literature. Cost, donor, social, and cultural aspects are least addressed. There is a lack of hard data in the literature regarding those problems.
authors.affiliation: Department of Medical Ethics, Faculté de médecine Necker, Centre Universitaire des Saints-Pères, Paris, France.
authors.forename: Gaoussou
authors.initials: G
authors.lastname: Toure
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Meningaud
authors.forename: Jacques-Charles
authors.initials: JC
authors.lastname: Bertrand
authors.forename: Christian
authors.initials: C
authors.lastname: Hervé
mesh_terms: D015706:Bibliometrics; D004992:Ethics, Medical; D005145:Face / Q000601:surgery*; D005151:Facial Injuries / Q000523:psychology / Q000601:surgery*; D006801:Humans; D010506:Periodicals as Topic / Q000639:trends; D011643:Publishing / Q000639:trends; D019651:Plastic Surgery Procedures / Q000941:ethics / Q000379:methods / Q000639:trends*; D018570:Risk Assessment; D014019:Tissue Donors / Q000941:ethics / Q000523:psychology; D016378:Tissue Transplantation / Q000941:ethics / Q000523:psychology