title: Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study.
abstract: BACKGROUND
  The risk to benefit ratio of face transplantation with a composite tissue allograft remains debatable, although this procedure is technically feasible. We report here a 1-year follow-up of a patient who underwent face transplantation with a composite tissue allograft.
  
  
  METHODS
  On Jan 21, 2007, a 29-year-old man with neurofibromatosis type 1 underwent resection of a massive plexiform neurofibroma diffusely infiltrating the middle and lower part of his face. The main goal was to restore both the cutaneous appearance and function of the face, including, in particular, control of orbicularis oculi and oris muscle contraction. The issues of immunosuppressive therapy, psychological outcome, and social reintergration were addressed, together with the monitoring of graft rejection by biopsies of the skin and mucosa.
  
  
  RESULTS
  The initial postoperative course was uncomplicated. Two episodes of clinical rejection occurred on days 28 and 64. The second episode was associated with cytomegalovirus infection. Both episodes resolved favourably, with no further clinical signs of rejection, making the reduction of immunosuppressive treatment possible. A year after surgery, the functional outcome was very good, with successful sensory and motor reinnervation in the transplanted territory. Psychological recovery was excellent, with complete social reintegration.
  
  
  CONCLUSIONS
  This case demonstrates the feasibility of surgically removing a large part of the face and replacing it with a composite tissue allograft. This facial repair procedure, which seems to have a satisfactory risk to benefit ratio, could be offered in rare and selected cases.
authors: Université Paris 12, Faculté de Médecine, IFR10, Créteil, France.
authors: Laurent
authors: L
authors: Lantieri
authors: Jean-Paul
authors: JP
authors: Meningaud
authors: Philippe
authors: P
authors: Grimbert
authors: Frank
authors: F
authors: Bellivier
authors: Jean-Pascal
authors: JP
authors: Lefaucheur
authors: Nicolas
authors: N
authors: Ortonne
authors: Marc-David
authors: MD
authors: Benjoar
authors: Philippe
authors: P
authors: Lang
authors: Pierre
authors: P
authors: Wolkenstein
mesh_terms: D000200:Action Potentials; D000328:Adult; D004576:Electromyography; D054445:Facial Transplantation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D018318:Neurofibroma, Plexiform / Q000523:psychology / Q000601:surgery*; D010297:Paris; D017060:Patient Satisfaction; D016378:Tissue Transplantation / Q000379:methods*
chemical_list: D007166:Immunosuppressive Agents