title: Vascular communications between donor and recipient tissues after successful full face transplantation.
abstract: The vascular reorganization after facial transplantation has important implications on future surgical planning. The purpose of this study was to evaluate blood flow (BF) after full face transplantation using wide area-detector computed tomography (CT) techniques. Three subjects with severe craniofacial injury who underwent full face transplantation were included. All subjects underwent a single anastomosis bilaterally of the artery and vein, and the recipient tongue was preserved. Before and after surgery, dynamic volume CT studies were analyzed for vascular anatomy and blood perfusion. Postsurgical CT showed extensive vascular reorganization for external carotid artery (ECA) angiosome; collateral flows from vertebral, ascending pharyngeal or maxillary arteries supplied the branches from the recipient ECAs distal to the ligation. While allograft tissue was slightly less perfused when the facial artery was the only donor artery when compared to an ECA-ECA anastomosis (4.4 ± 0.4% vs. 5.7 ± 0.7%), allograft perfusion was higher than the recipient normal neck tissue. BF for the recipient tongue was maintained from contralateral/donor arteries when the lingual artery was sacrificed. Venous drainage was adequate for all subjects, even when the recipient internal jugular vein was anastomosed in end-to-end fashion on one side. In conclusion, dynamic CT identified adequate BF for facial allografts via extensive vascular reorganization.
authors: Applied Imaging Science Laboratory, Department of Radiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA.
authors: K K
authors: KK
authors: Kumamaru
authors: G C
authors: GC
authors: Sisk
authors: D
authors: D
authors: Mitsouras
authors: K
authors: K
authors: Schultz
authors: M L
authors: ML
authors: Steigner
authors: E
authors: E
authors: George
authors: D S
authors: DS
authors: Enterline
authors: E M
authors: EM
authors: Bueno
authors: B
authors: B
authors: Pomahac
authors: F J
authors: FJ
authors: Rybicki
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D005145:Face / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D054445:Facial Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D014019:Tissue Donors
keywords: Collateral flow; computed tomography; full face transplantation; surgical outcomes; vascular anastomosis