Facial transplantation.
OBJECTIVE
Twenty-one face transplants have been performed to date. This review provides an overview of the clinical outcomes and the lessons learned from these initial cases.


RESULTS
Facial transplantation has progressed over the past 10 years from an experimental possibility to a clinical reality. The most recent transplants performed in the USA, Spain and Turkey involve the full face. Good sensory recovery of the allograft has been consistently reported, even in the absence of nerve repair. As predicted, motor recovery has been slower than re-innervation of sensation. Dramatic improvements to functional status have been seen, with recipients regaining the ability to smile, smell, eat, drink and speak. Episodes of acute rejection have been common and controlled with increases in systemic immunosuppression. The first face transplant recipient is now over 5 years after surgery. Chronic rejection has not been seen in her or any other case. Despite the encouraging outcomes, complications because of immunosuppression, including malignancy, have occurred.


CONCLUSIONS
The outcomes of facial transplantation thus far have been very encouraging. The development of standardized tools to measure functional and psychological outcomes is required as more cases are performed. We recommend that facial transplantation is still only to be performed by experienced multidisciplinary teams.
Royal Free Hospital, University College London, London, UK.
Kumaran
K
Shanmugarajah
Shehan
S
Hettiaratchy
Peter E M
PE
Butler
D004954:Esthetics; D005149:Facial Expression; D005151:Facial Injuries / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005152:Facial Muscles / Q000294:innervation; D020220:Facial Nerve Injuries / Q000503:physiopathology / Q000601:surgery; D054445:Facial Transplantation / Q000379:methods* / Q000502:physiology / Q000523:psychology; D006084:Graft Rejection / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008866:Microsurgery / Q000379:methods; D009046:Motor Neurons / Q000502:physiology; D009416:Nerve Regeneration / Q000502:physiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D011788:Quality of Life / Q000523:psychology; D011984:Sensory Receptor Cells / Q000502:physiology; D016896:Treatment Outcome; D061221:Trigeminal Nerve Injuries / Q000601:surgery
D007166:Immunosuppressive Agents