Aesthetic and functional facial transplantation: a classification system and treatment algorithm.
BACKGROUND
As of July of 2013, 27 facial vascularized composite allotransplantations have been performed. The authors developed a classification system and treatment algorithm that is practical and surgically applicable.


METHODS
The majority of the transplants have been described in the surgical literature and the media, and a review of the data was performed. A classification system and a treatment algorithm were designed. Skeletal defects were defined by craniofacial osteotomies and soft-tissue defects by aesthetic facial subunits. The soft-tissue defect was subdivided into the following subunits: oral-nasal (type 1), oronasal-orbital (type 2), and full facial (type 3). The bony defects were subdivided into mandibular involvement (M), Le Fort 1 (A), Le Fort 3 (B), and monobloc (C).


RESULTS
The mechanisms of injury included trauma (n = 13), burns (n = 8), congenital deformity (n = 3), oncologic resection (n = 1), and unreported (n = 2). According to the proposed classification system: one was type 1; one was type 1-M; one was type 1-MB; two were type 2; two were type 2-B; two were type 2-MB; six were type 3; one was type 3-B; and three were type 3-MB; eight could not be classified due to a lack of data. The treatment algorithm designed a vascularized composite allotransplantation that addressed the bony and soft-tissue components.


CONCLUSIONS
Patient selection for these complicated procedures, currently dependent on lifelong immunosuppression, is crucial to their success. The authors describe a classification system and treatment algorithm for facial defects that may be ideally suited for facial transplantation. The proposed classification and algorithm may help centers define indications and ideally improve patient outcomes.


METHODS
Therapeutic, V.
Baltimore, Md. From the Division of Plastic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine.
Raja
R
Mohan
Daniel E
DE
Borsuk
Amir H
AH
Dorafshar
Howard D
HD
Wang
Branko
B
Bojovic
Michael R
MR
Christy
Eduardo D
ED
Rodriguez
D000328:Adult; D000465:Algorithms; D004954:Esthetics; D054445:Facial Transplantation / Q000145:classification*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult