Total face, double jaw, and tongue transplant research procurement:  an educational model.
BACKGROUND
Transplantation of a facial vascularized composite allograft is a highly complex procedure that requires meticulous planning and affords little room for error. Although cadaveric dissections are an essential preparatory exercise, they cannot simulate the true clinical experience of facial vascularized composite allograft recovery.


METHODS
After obtaining institutional review board approval to perform a facial vascularized composite allograft research procurement, a 66-year-old, brain-dead donor was identified. The family graciously consented to donation of a total face, double jaw, and tongue allograft and multiple solid organs.


RESULTS
A craniofacial computed tomographic angiogram was obtained preoperatively to define the vascular anatomy and facilitate virtual computerized surgical planning. The allograft was procured in 10 hours, with an additional 2 hours required for an open tracheostomy and silicone facial impression. The donor was coagulopathic throughout the recovery, resulting in an estimated blood loss of 1500 ml. Fluorescence angiography confirmed adequate perfusion of the entire allograft based on lingual and facial arterial and external jugular and thyrolinguofacial venous pedicles. The solid organ transplant team initiated abdominal organ isolation while the facial allograft procurement was in progress. After completion of allograft recovery, the kidneys and liver were recovered without complication.


CONCLUSIONS
Before conducting a clinical face transplant, adequate preparation is critical to maximize vascularized composite allotransplantation outcomes and preserve solid organ allograft function. As more centers begin to perform facial transplantation, research procurement of a facial vascularized composite allograft offers a unique educational opportunity for the surgical and anesthesia teams, the organ procurement organization, and the institution.
Baltimore, Md. From the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine, and the Living Legacy Foundation of Maryland.
Branko
B
Bojovic
Amir H
AH
Dorafshar
Emile N
EN
Brown
Michael R
MR
Christy
Daniel E
DE
Borsuk
Helen G
HG
Hui-Chou
Cynthia K
CK
Shaffer
T Nicole
TN
Kelley
Paula J
PJ
Sauerborn
Karen
K
Kennedy
Mary
M
Hyder
Philip S
PS
Brazio
Benjamin
B
Philosophe
Rolf N
RN
Barth
Thomas M
TM
Scalea
Stephen T
ST
Bartlett
Eduardo D
ED
Rodriguez
D000368:Aged; D059925:Anatomic Landmarks; D001926:Brain Death; D005145:Face / Q000098:blood supply / Q000601:surgery*; D005149:Facial Expression; D054445:Facial Transplantation / Q000379:methods*; D005451:Fluorescein Angiography / Q000379:methods; D006801:Humans; D017145:Models, Educational; D056948:Orthognathic Surgical Procedures; D011300:Preoperative Care / Q000379:methods; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014059:Tongue / Q000601:surgery*; D014184:Transplantation, Homologous