title: Long-Term Multifunctional Outcome and Risks of Face Vascularized Composite Allotransplantation.
abstract: Vascularized composite allotransplantation (VCA) to reconstruct complex centrally located facial defects and to restore vital functions in a 1-staged procedure has worldwide gained acceptance. Continuous long-term multidisciplinary follow-up of face transplant patients is mandatory for surveillance of the complications associated with the immunosuppressive regime and for functional assessment of the graft. In December 2011, our multidisciplinary team performed a digitally planned face transplant at the Ghent University Hospital, Belgium on a 55-year-old man with a large central facial defect after a high-energy ballistic injury. The patient was closely followed to assess functional recovery, immunosuppressive complications, overall well-being, and quality of life. Three years postoperatively, the patient and his family are very satisfied with the overall outcome, and social reintegration in the community is successful. Motor and sensory functions have recovered near normal. Infectious and medical complications have been serious but successfully managed. Immunosuppressive maintenance therapy consists of corticoids, tacrolimus, and mycophenolate mofetil in minimal doses. Epithetic reconstruction of both eyes gave a tremendous improvement on the overall aesthetic outcome. Despite serious complications during the first 12 months, multifunctional outcome in the first face transplant in Belgium (#19 worldwide) is successful. This should be attributed to the continuous and long-term multidisciplinary team approach. As only few reports of other face transplant patients on long-term follow-up are available, more data need to be collected and reported to further outweigh the risk benefit ratio of this life changing surgery.
authors.affiliation: *Department of Plastic and Reconstructive Surgery †Department of Head and Neck and Maxillo-Facial Surgery ‡Department of Nephrology §Department of Psychiatry, Ghent University Hospital, Ghent ||Center for Craniofacial Epithetics, Zaventem ¶Department of Speech, Language and Hearing Sciences, Ghent University Hospital, Ghent, Belgium.
authors.forename: Nathalie A
authors.initials: NA
authors.lastname: Roche
authors.forename: Phillip N
authors.initials: PN
authors.lastname: Blondeel
authors.forename: Hubert F
authors.initials: HF
authors.lastname: Vermeersch
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Peeters
authors.forename: Gilbert M D
authors.initials: GM
authors.lastname: Lemmens
authors.forename: Jan
authors.initials: J
authors.lastname: De Cubber
authors.forename: Miet
authors.initials: M
authors.lastname: De Letter
authors.forename: Kristiane
authors.initials: K
authors.lastname: Van Lierde
mesh_terms: D064595:Composite Tissue Allografts / Q000637:transplantation*; D003198:Computer Simulation; D003265:Contingent Negative Variation / Q000502:physiology; D004576:Electromyography / Q000379:methods; D005137:Eye, Artificial; D005151:Facial Injuries / Q000601:surgery; D054445:Facial Transplantation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D020273:Orbital Implants; D010347:Patient Care Planning; D010348:Patient Care Team; D017060:Patient Satisfaction; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology; D013065:Speech Intelligibility / Q000502:physiology; D016559:Tacrolimus / Q000627:therapeutic use; D014110:Touch / Q000502:physiology; D016896:Treatment Outcome; D063986:Vascularized Composite Allotransplantation / Q000379:methods*; D014948:Wounds, Gunshot / Q000601:surgery
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus