The technical and anatomical aspects of the World's first near-total human face and maxilla transplant.
OBJECTIVE
To discuss the technical and anatomical analysis and design of an osteocutaneous allograft transplant incorporating the donor maxilla and the execution of the operative protocol during the transplant.


METHODS
The Cleveland Clinic reported the world's first successful combined face and maxilla transplant in December 2008. Unlike the 3 prior face transplants, this surgical procedure was done as a salvage operation in a patient who had undergone 23 major reconstructive procedures. The additional complexity due to significant postoperative scarring and recipient vessel depletion presented a unique challenge in this case. The extensive 3-dimensional losses of facial structures in multiple tissue planes required a Le Fort III osteomyocutaneous allotransplant incorporating the donor maxilla.


RESULTS
We report the first successful transfer of a complete bony framework and soft-tissue envelope. The allograft has shown excellent integration and no long-term rejection. The traditional conception based on anatomical studies suggested that this transfer would require independent dissection of the internal maxillary vascular system. This was not required in our patient whose allograft was based solely on the facial arterial system and its arcades.


CONCLUSIONS
Successful near-total face and maxilla allograft transplant can be accomplished based on the facial arterial system and its arcades. This presents a novel method for reconstructing massive facial injuries with significant involvement of the facial skeleton.
Alam
Daniel S
DS
The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk A71, Cleveland, OH 44195, USA. alamd@ccf.org
Papay
Frank
F
Djohan
Risal
R
Bernard
Steven
S
Lohman
Robert
R
Gordon
Chad R
CR
Hendrickson
Mark
M
Siemionow
Maria
M
D016025:Bone Transplantation / Q000379:methods*; D003131:Combined Modality Therapy; D004954:Esthetics; D005145:Face / Q000033:anatomy & histology / Q000601:surgery; D005151:Facial Injuries / Q000209:etiology / Q000601:surgery*; D054445:Facial Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging; D008437:Maxilla / Q000637:transplantation*; D008446:Maxillofacial Injuries / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D019340:Osteotomy, Le Fort / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery