Procurement of total human face graft for allotransplantation: a preclinical study and the first clinical case.
BACKGROUND
The authors report the technical difficulties involved in the procurement of a total human face graft for allotransplantation.


METHODS
After completing a preclinical study that involved 13 fresh cadavers, the authors harvested a total face graft for allotransplantation onto a patient in April of 2009. The harvested tissue specimen included the entire face along with the scalp and the auricles. The authors then removed the unnecessary parts, specifically, the lips and the skin overlying the chin.


RESULTS
The preclinical study and clinical results confirmed that complete revascularization of a total face graft, complete with the scalp and auricles, from a single external carotid vascular pedicle was possible. All dissections were completed in less than 6 hours during the preclinical study. Graft procurement for the clinical case took 11 hours. Facial soft tissues were harvested en bloc to decrease graft harvest time and prevent tissue injury. A resin mask that covered the entire face of the donor provided excellent cosmetic results. All nerves and eyelid structures were easily reattached. One month after transplantation, skin necrosis necessitated several stages of excision. Biopsy specimens from the transplanted tissue were negative for immune-mediated rejection. Unfortunately, the patient experienced a cardiac arrest during follow-up surgery and died 2 months after the transplant procedure.


CONCLUSIONS
A composite tissue allotransplantation of the total face along with the scalp and the auricles is technically feasible. The authors' flap provided reliable vascularization and was obtained in a standardized fashion in less than 11 hours. The graft contained all of the perioral muscles, branches of the facial nerve, eyelid structures, and major salivary glands.
Meningaud
Jean-Paul
JP
Créteil, France From the Université Paris 12, Faculté de Médecine, IFR10, and AP-HP, Groupe Henri Mondor-Albert Chenevier, Service de Chirurgie Plastique, Reconstructrice, et Esthétique.
Benjoar
Marc-David
MD
Hivelin
Mickael
M
Hermeziu
Oana
O
Toure
Gaoussou
G
Lantieri
Laurent
L
D000328:Adult; D002102:Cadaver; D002342:Carotid Artery, External / Q000601:surgery; D003646:Debridement; D005145:Face / Q000098:blood supply* / Q000294:innervation / Q000473:pathology / Q000601:surgery; D054445:Facial Transplantation / Q000379:methods*; D017809:Fatal Outcome; D005602:France; D006323:Heart Arrest; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D009336:Necrosis; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents