title: Optimizing Reconstruction with Periorbital Transplantation: Clinical Indications and Anatomic Considerations.
abstract: Complex periorbital subunit reconstruction is challenging because the goals of effective reconstruction vary from one individual to another. The purpose of this article is to explore the indications and anatomic feasibility of periorbital transplantation by reviewing our institutional repository of facial injury.
  
  
  METHODS
  Institutional review board approval was obtained at the R Adams Cowley Shock Trauma Center for a retrospective chart review conducted on patients with periorbital defects. Patient history, facial defects, visual acuity, and periorbital function were critically reviewed to identify indications for periorbital or total face (incorporating the periorbital subunit) vascularized composite allotransplantation. Cadaveric allograft harvest was then designed and performed for specific patient defects to determine anatomic feasibility. Disease conditions not captured by our patient population warranting consideration were reviewed.
  
  
  RESULTS
  A total of 7 facial or periorbital transplant candidates representing 6 different etiologies were selected as suitable indications for periorbital transplantation. Etiologies included trauma, burn, animal attack, and tumor, whereas proposed transplants included isolated periorbital and total face transplants. Allograft recovery was successfully completed in 4 periorbital subunits and 1 full face. Dual vascular supply was achieved in 5 of 6 periorbital subunits (superficial temporal and facial vessels).
  
  
  CONCLUSIONS
  Transplantation of isolated periorbital structures or full face transplantation including periorbital structures is technically feasible. The goal of periorbital transplantation is to re-establish protective mechanisms of the eye, to prevent deterioration of visual acuity, and to optimize aesthetic outcomes. Criteria necessary for candidate selection and allograft design are identified by periorbital defect, periorbital function, ophthalmologic evaluation, and defect etiology.
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md.
authors.forename: Michael
authors.initials: M
authors.lastname: Sosin
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md.
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Dorafshar
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Iliff
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md.
authors.forename: Joani M
authors.initials: JM
authors.lastname: Christensen
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Christy
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md.
authors.forename: Branko
authors.initials: B
authors.lastname: Bojovic
authors.affiliation: Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, N.Y.; Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma, Center, University of Maryland Medical Center, Baltimore, Md.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md.; Department of Ophthalmology, Johns Hopkins Bellevue Medical Center, Baltimore, Md.
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez