Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation: The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles.
The application of aesthetic, craniofacial, and microsurgical principles in the execution of face transplantation may improve outcomes. Optimal soft-tissue face transplantation can be achieved by incorporating subunit facial skeletal replacement and subsequent tissue resuspension. The purpose of this study was to establish a reconstructive solution for a full face and scalp burn and to evaluate outcome precision and consistency.



Seven mock face transplants (14 cadavers) were completed in the span of 1 year. Components of the vascularized composite allograft included the eyelids, nose, lips, facial muscles, oral mucosa, total scalp, and ears; and skeletal subunits of the zygoma, nasal bone, and genial segment. Virtual surgical planning was used for osteotomy selection, and to evaluate postoperative precision of hard- and soft-tissue elements.



Each transplant experience decreased each subsequent transplant surgical time. Prefabricated cutting guides facilitated a faster dissection of both donor and recipient tissue, requiring minimal alteration to the allograft for proper fixation of bony segments during inset. Regardless of donor-to-recipient size discrepancy, ample soft tissue was available to achieve tension-free allograft inset. Differences between virtual transplant simulation and posttransplant measurements were minimal or insignificant, supporting replicable and precise outcomes.



This facial transplant model was designed to optimize reconstruction of extensive soft-tissue defects of the craniofacial region representative of electrical, thermal, and chemical burns, by incorporating skeletal subunits within the allograft. The implementation of aesthetic, craniofacial, and microsurgical principles and computer-assisted technology improves surgical precision, decreases operative time, and may optimize function.
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Michael
M
Sosin
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Daniel J
DJ
Ceradini
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Alexes
A
Hazen
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Jamie P
JP
Levine
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
David A
DA
Staffenberg
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Pierre B
PB
Saadeh
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Roberto L
RL
Flores
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Lawrence E
LE
Brecht
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
G Leslie
GL
Bernstein
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Eduardo D
ED
Rodriguez
D002056:Burns / Q000601:surgery; D002102:Cadaver; D002508:Cephalometry; D064595:Composite Tissue Allografts; D004210:Dissection; D004431:Ear, External / Q000637:transplantation; D004954:Esthetics; D005143:Eyelids / Q000637:transplantation; D005145:Face / Q000098:blood supply / Q000294:innervation / Q000601:surgery*; D005147:Facial Bones / Q000637:transplantation; D005151:Facial Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D054445:Facial Transplantation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008866:Microsurgery; D008953:Models, Anatomic; D010027:Osteotomy / Q000379:methods; D012535:Scalp / Q000637:transplantation; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D063986:Vascularized Composite Allotransplantation / Q000379:methods*