title: Reconstruction of a severe facial defect by allotransplantation in neurofibromatosis type 1: a case report.
abstract: BACKGROUND
  On January 26, 2010, our team performed a facial transplant for a patient with neurofibromatosis type 1. We detail the perioperative surgical strategies for the composite tissue allograft (CTA) of the lower parts of the face to restore a severe defect after excision of bilateral massive plexiform neurofibromas. The main distinctive feature included an innovative provisional heterotopic transplantation (PHT) technique of the facial allograft to the femoral vessels before its final orthotopic transplantation.
  
  
  METHODS
  A 35-year-old Caucasian man received a CTA of the lower two-thirds of the face, including a chin osseous segment. The face was obtained from a non-heart-beating donor. The sequence of microsurgical procedures began by performing a PHT of the CTA to the recipient's femoral vessels in the right thigh. Intraoperatively, he experienced considerable blood loss that required transfusion of 24 units of packed cells. Surgical revision was required at day 7 to remove an extensive hematoma in the right side of the CTA. The maintenance immunosuppressive regimen included steroids, mycophenolate mofetil, and tacrolimus.
  
  
  CONCLUSIONS
  We have reported a case of successful provisional transplantation of a human facial allograft onto the thigh as an alternative technique in human face transplantation. PHT was a reliable alternative procedure to obtain the facial allograft from a cadaveric donor.
authors.affiliation: Plastic and Reconstructive Surgery Department, Virgen del Rocio University Hospital, Sevilla, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Sicilia-Castro
authors.forename: T
authors.initials: T
authors.lastname: Gomez-Cia
authors.forename: P
authors.initials: P
authors.lastname: Infante-Cossio
authors.forename: P
authors.initials: P
authors.lastname: Gacto-Sanchez
authors.forename: F
authors.initials: F
authors.lastname: Barrera-Pulido
authors.forename: A
authors.initials: A
authors.lastname: Lagares-Borrego
authors.forename: R
authors.initials: R
authors.lastname: Narros-Gimenez
authors.forename: A
authors.initials: A
authors.lastname: Garcia-Perla
authors.forename: J M
authors.initials: JM
authors.lastname: Hernandez-Guisado
authors.forename: J D
authors.initials: JD
authors.lastname: Gonzalez-Padilla
mesh_terms: D000328:Adult; D054445:Facial Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D009456:Neurofibromatosis 1 / Q000601:surgery*; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus