title: Noninvasive vascular images for face transplant surgical planning.
abstract: OBJECTIVE
  Face transplantation replaces substantial defects with anatomically identical donor tissues; preoperative vascular assessment relies on noninvasive imaging to separate and characterize the external carotid vessels and branches. The objective is to describe and illustrate vascular considerations for face transplantation candidates.
  
  
  METHODS
  Novel noninvasive imaging using computed tomography and magnetic resonance imaging over 3 spatial dimensions plus time was developed and tested in 4 face transplant candidates. Precontrast images assessed bones and underlying metal. Contrast media was used to delineate and separate arteries from veins. For computed tomography, acquisition over multiple time points enabled the computation of tissue perfusion metrics. Time-resolved magnetic resonance angiography was performed to separate arterial and venous phases.
  
  
  RESULTS
  The range of circulation times for the external carotid system was 6 to 14 seconds from arterial blush to loss of venous enhancement. Precontrast imaging provided a roadmap of bones and metal. Among the 4 patients, 3 had surgical clips, metal implants, or both within 1 cm of major vessels considered for surgery. Contrast-enhanced wide area detector computed tomographic data acquired in the axial mode separated these structures and provided arterial and venous images for planning the surgical anastomoses. Magnetic resonance imaging was able to distinguish between the large vessels from the external carotid systems.
  
  
  CONCLUSIONS
  Vascular imaging maps are challenging in face transplantation because of the rapid circulation times and artifact from the initial injury, prior reconstructive attempts, or both. Nevertheless, face transplant candidates require high spatial and temporal resolution vascular imaging to determine those vessels appropriate for surgical anastomoses.
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Soga
authors.forename: Nicole
authors.initials: N
authors.lastname: Wake
authors.forename: Ericka M
authors.initials: EM
authors.lastname: Bueno
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steigner
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mitsouras
authors.forename: Kurt
authors.initials: K
authors.lastname: Schultz
authors.forename: J Rodrigo
authors.initials: JR
authors.lastname: Diaz-Siso
authors.forename: Geoffroy C
authors.initials: GC
authors.lastname: Sisk
authors.forename: Richard
authors.initials: R
authors.lastname: Prior
authors.forename: Sara L
authors.initials: SL
authors.lastname: Powers
authors.forename: Jason
authors.initials: J
authors.lastname: Signorelli
authors.forename: Camille K
authors.initials: CK
authors.lastname: Jania
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki