Near-total human face transplantation for a severely disfigured patient in the USA.
BACKGROUND
Multiple reconstructive procedures are common for the reconstruction of complex facial deformities of skin, soft tissues, bony structures, and functional subunits, such as the nose, lips, and eyelids. However, the results have been unsatisfactory. An innovative approach entailing a single surgical procedure of face allograft transplantation is a viable alternative and gives improved results.


METHODS
On Dec 9, 2008, a 45-year-old woman with a history of severe midface trauma underwent near-total face transplantation in which 80% of her face was replaced with a tailored composite tissue allograft. We addressed issues of immunosuppressive therapy, psychological and ethical outcomes, and re-integration of the patient into society.


RESULTS
After the operation, the patient did well physically and psychologically, and tolerated immunosuppression without any major complication. Routine biopsy on day 47 after transplantation showed rejection of graft mucosa; however, a single bolus of corticosteroids reversed rejection. During the first 3 weeks after transplantation, the patient accepted her new face; 6 months after surgery, the functional outcome has been excellent. In contrast to her status before transplantation, the patient can now breathe through her nose, smell, taste, speak intelligibly, eat solid foods, and drink from a cup.


CONCLUSIONS
We show the feasibility of reconstruction of severely disfigured patients in a single surgical procedure using composite face allotransplantation. Therefore, this should be taken in consideration as an early option for severely disfigured patients.


BACKGROUND
None.
Siemionow
Maria
M
Cleveland Clinic, Cleveland, OH 44195, USA. siemiom@ccf.org
Papay
Frank
F
Alam
Daniel
D
Bernard
Steven
S
Djohan
Risal
R
Gordon
Chad
C
Hendrickson
Mark
M
Lohman
Robert
R
Eghtesad
Bijan
B
Coffman
Kathy
K
Kodish
Eric
E
Paradis
Carmen
C
Avery
Robin
R
Fung
John
J
D001828:Body Image; D046148:Donor Selection; D005081:Exercise Therapy; D005151:Facial Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D054445:Facial Transplantation / Q000941:ethics / Q000379:methods* / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D018579:Patient Selection; D011859:Radiography; D020127:Recovery of Function; D009927:Tissue and Organ Procurement; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014481:United States; D014948:Wounds, Gunshot / Q000150:complications