Total face, double jaw, and tongue transplantation:  an evolutionary concept.
BACKGROUND
The central face high-energy avulsive injury has been frequently encountered and predictably managed at the R Adams Cowley Shock Trauma Center. However, despite significant surgical advances and multiple surgical procedures, the ultimate outcome continues to reveal an inanimate, insensate, and suboptimal aesthetic result.


METHODS
To effectively address this challenging deformity, a comprehensive multidisciplinary approach was devised. The strategy involved the foundation of a basic science laboratory, the cultivation of a supportive institutional clinical environment, the innovative application of technologies, cadaveric simulations, a real-time clinical rehearsal, and an informed and willing recipient who had the characteristic deformity.


RESULTS
After institutional review board and organ procurement organization approval, a total face, double jaw, and tongue transplantation was performed on a 37-year-old man with a central face high-energy avulsive ballistic injury.


CONCLUSIONS
This facial transplant represents the most comprehensive transplant performed to date. Through a systematic approach and clinical adherence to fundamental principles of aesthetic surgery, craniofacial surgery, and microsurgery and the innovative application of technologies, restoration of human appearance and function for individuals with a devastating composite disfigurement is now a reality.


METHODS
Therapeutic, V.
Baltimore, Md. From the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, University of Maryland School of Medicine.
Amir H
AH
Dorafshar
Branko
B
Bojovic
Michael R
MR
Christy
Daniel E
DE
Borsuk
Nicholas T
NT
Iliff
Emile N
EN
Brown
Cynthia K
CK
Shaffer
T Nicole
TN
Kelley
Debra L
DL
Kukuruga
Rolf N
RN
Barth
Stephen T
ST
Bartlett
Eduardo D
ED
Rodriguez
D000328:Adult; D005151:Facial Injuries / Q000601:surgery*; D054445:Facial Transplantation; D006801:Humans; D007568:Jaw / Q000637:transplantation*; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014059:Tongue / Q000637:transplantation*; D014948:Wounds, Gunshot / Q000601:surgery*