title: Restoration of facial form and function after severe disfigurement from burn injury by a composite facial allograft.
abstract: Composite facial allotransplantation is emerging as a treatment option for severe facial disfigurements. The technical feasibility of facial transplantation has been demonstrated, and the initial clinical outcomes have been encouraging. We report an excellent functional and anatomical restoration 1 year after face transplantation. A 59-year-old male with severe disfigurement from electrical burn injury was treated with a facial allograft composed of bone and soft tissues to restore midfacial form and function. An initial potent antirejection treatment was tapered to minimal dose of immunosuppression. There were no surgical complications. The patient demonstrated facial redness during the initial postoperative months. One acute rejection episode was reversed with a brief methylprednisolone bolus treatment. Pathological analysis and the donor's medical history suggested that rosacea transferred from the donor caused the erythema, successfully treated with topical metronidazol. Significant restoration of nasal breathing, speech, feeding, sensation and animation was achieved. The patient was highly satisfied with the esthetic result, and regained much of his capacity for normal social life. Composite facial allotransplantation, along with minimal and well-tolerated immunosuppression, was successfully utilized to restore facial form and function in a patient with severe disfigurement of the midface.
authors.affiliation: Division of Plastic Surgery Division of Otolaryngology Division of Transplant Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. bpomahac@partners.org
authors.forename: B
authors.initials: B
authors.lastname: Pomahac
authors.forename: J
authors.initials: J
authors.lastname: Pribaz
authors.forename: E
authors.initials: E
authors.lastname: Eriksson
authors.forename: D
authors.initials: D
authors.lastname: Annino
authors.forename: S
authors.initials: S
authors.lastname: Caterson
authors.forename: C
authors.initials: C
authors.lastname: Sampson
authors.forename: Y
authors.initials: Y
authors.lastname: Chun
authors.forename: D
authors.initials: D
authors.lastname: Orgill
authors.forename: D
authors.initials: D
authors.lastname: Nowinski
authors.forename: S G
authors.initials: SG
authors.lastname: Tullius
mesh_terms: D002058:Burns, Electric / Q000473:pathology / Q000601:surgery*; D005151:Facial Injuries / Q000473:pathology / Q000601:surgery*; D054445:Facial Transplantation / Q000009:adverse effects / Q000379:methods* / Q000473:pathology / Q000502:physiology; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012393:Rosacea / Q000209:etiology / Q000473:pathology