First human face allograft: early report.
BACKGROUND
Extended soft tissue defects of the face are difficult to reconstruct, and autologous tissue transfers usually lead to poor cosmetic and functional outcomes. We judged that composite tissue transplantation could be valuable in facial reconstructive surgery.


METHODS
We transplanted the central and lower face of a brain-dead woman onto a woman aged 38 years who had suffered amputation of distal nose, both lips, chin, and adjacent parts of the cheeks. Transplantation consisted of revascularisation of right and left facial arteries and veins (ischaemic time 4 h), mucosal repair of oral and nasal vestibules, bilateral anastomoses of infraorbital and mental sensitive nerves, joining of mimic muscles with motor nerve suture on mandibular branch of the left facial nerve, and skin closure. Immunosuppressive treatment was with thymoglobulin, tacrolimus, mycophenolate mofetil, and prednisone. Two infusions of donor bone-marrow cells were given. Follow-up included routine tests, biopsies, physiotherapy, and psychological support.


RESULTS
The initial postoperative course was uneventful. No surgical complication occurred. Bone-marrow graft and immunosuppression were well tolerated. Mild clinical signs of rejection were seen at day 20. Increased corticoids initially did not reverse rejection, but signs of rejection disappeared after three boluses of prednisone. Anatomical and psychological integration and recovery of sensation were excellent. At the end of the first postoperative week, the patient could eat, and speech improved quickly. Passive transmission of muscle contractions to the graft already exists; physiotherapy is being done to restore dynamic motions around the lips.


CONCLUSIONS
The 4-month outcome demonstrates the feasibility of this procedure. The functional result will be assessed in the future, but this graft can already be deemed successful with respect to appearance, sensitivity, and acceptance by the patient.
Devauchelle
Bernard
B
Departement of Maxillofacial Surgery, Centre Hospitalier Universitaire Amiens, France. devauchelle.bernard@chu-amiens.fr
Badet
Lionel
L
Lengelé
Benoit
B
Morelon
Emmanuel
E
Testelin
Sylvie
S
Michallet
Mauricette
M
D'Hauthuille
Cédric
C
Dubernard
Jean-Michel
JM
D000328:Adult; D016026:Bone Marrow Transplantation; D005151:Facial Injuries / Q000601:surgery*; D005152:Facial Muscles / Q000637:transplantation*; D005154:Facial Nerve / Q000637:transplantation*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy / Q000534:rehabilitation; D019651:Plastic Surgery Procedures / Q000941:ethics / Q000379:methods* / Q000523:psychology
D007166:Immunosuppressive Agents