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.
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.
Lantieri
Laurent
L
Université Paris 12, Faculté de Médecine, IFR10, Créteil, France.
Meningaud
Jean-Paul
JP
Grimbert
Philippe
P
Bellivier
Frank
F
Lefaucheur
Jean-Pascal
JP
Ortonne
Nicolas
N
Benjoar
Marc-David
MD
Lang
Philippe
P
Wolkenstein
Pierre
P
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*
D007166:Immunosuppressive Agents