title: Two-stage face transplantation: a new concept in vascularized composite allotransplantation.
abstract: BACKGROUND
  Animal models and clinical cases of facial allotransplantation have been performed as a single stage procedure. A staged surgery might offer some advantages in selected cases. In this study, a two-stage face transplantation approach was performed on rat and the feasibility and safety were evaluated.
  
  
  METHODS
  Brown Norway rats were used as donors and Lewis rats as recipients in the allotransplantation groups. A total of 33 hemiface-scalp transplantations were performed. Syngeneic orthotopic transplantations were performed either in one-stage (one single stage surgery; N = 3), local two-stage [heterothopic transplantation to the neck during the first stage and graft rotation as a pedicled flap to cover the facial defect on postoperative day (POD) 2; N = 3], or distant two-stage approaches (heterothopic transplantation to the groin during the first stage and free graft transfer to the face on postoperative day 2; N = 3). In the allotransplantation groups using the same approaches, 12 received no treatment (N = 4 each subgroup) and 12 received the same tapering dose of cyclosporine (10 to 2 mg/Kg/day; N = 4 each subgroup). Graft survival and the rejection grades were assessed clinically and pathologically.
  
  
  RESULTS
  All syngeneic transplants survived for the follow-up period of 180 days. The mean rejection-free survival and total survival of the allograft in the no treatment group was 6 ± 0.3 and 14.3 ± 4.5 days in the one-stage group, 6 ± 0.4 and 18.5 ± 1 days in the local two-stage group and 6 ± 0.2 and 14.3 ± 5.7 (P > 0.05). All allografts in the treatment groups did not develop rejection during the 42 days follow-up period.
  
  
  CONCLUSIONS
  It is feasible, reliable, reproducible, and safe to perform a two-stage face transplantation in rats. This novel approach has the potential to be applied in research and eventually in selected clinical cases of facial allotransplantation.
authors.affiliation: Former Microsurgery Fellow, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Plastic and Reconstructive Surgery, Pontifical Catholic University of Chile, Santiago, Chile.
authors.forename: Alejandro E
authors.initials: AE
authors.lastname: Ramirez
authors.forename: William W
authors.initials: WW
authors.lastname: Lao
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Wang
authors.forename: Hui-Yun
authors.initials: HY
authors.lastname: Cheng
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
mesh_terms: D000818:Animals; D054445:Facial Transplantation / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D008297:Male; D051381:Rats; D011914:Rats, Inbred BN; D011917:Rats, Inbred Lew; D015203:Reproducibility of Results