title: The role of face transplantation in the self-inflicted gunshot wound.
abstract: BACKGROUND
  Facial self-inflicted gunshot wounds (SIGSWs) cause a devastating midfacial defect and pose a challenging problem to the reconstructive surgeon. Face transplantation (FT) has the potential for near-normal restoration in otherwise non-reconstructible defects. Two out of 7 FT recipients at Brigham and Women's Hospital (BWH) sustained SIGSWs. In this study, we illustrate the role of FT in the management of SIGSWs through an aesthetic, functional, and psychosocial examination of outcomes.
  
  
  METHODS
  We performed a retrospective analysis of individuals with SIGSWs who were screened at BWH between 2008 and 2015. We then collected data of the injuries, modes of conventional reconstruction (CR), and deficits. For the FT recipients, we critically reviewed the psychosocial screening process and post-transplantation aesthetic, functional, and psychosocial outcomes.
  
  
  RESULTS
  A total of six individuals post-SIGSWs were screened for FT. All of them had undergone CR, with five receiving loco-regional flaps and free tissue transfers, and one undergoing serial debridement and primary soft-tissue repair. Following CR, all suffered from residual functional and aesthetic deficits. Two underwent partial FT and one is currently undergoing FT screening. We describe the pre-transplant psychosocial screening process and the aesthetic, functional, and psychosocial outcomes of the SIGSW FT recipients.
  
  
  CONCLUSIONS
  We examined the facial SIGSW injury, outcomes of CR, and the mechanism of FT to offer a potential solution to the shortcomings of CR. More importantly, we highlight the critical nature of the psychosocial component of the multidisciplinary evaluation given the history of mental illness and suicidal behavior in this subset of patients.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Harriet
authors.initials: H
authors.lastname: Kiwanuka
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Mario A
authors.initials: MA
authors.lastname: Aycart
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Gitlin
authors.affiliation: Department of Social Work, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Devine
authors.affiliation: MGH Institute of Health Professions, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Bridget J
authors.initials: BJ
authors.lastname: Perry
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Thet-Su
authors.initials: TS
authors.lastname: Win
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Ericka M
authors.initials: EM
authors.lastname: Bueno
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Muayyad
authors.initials: M
authors.lastname: Alhefzi
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Nicco
authors.initials: N
authors.lastname: Krezdorn
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. Electronic address: bpomahac@partners.org.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods; D003658:Decision Making, Computer-Assisted; D005151:Facial Injuries / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000601:surgery; D054445:Facial Transplantation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D011580:Psychological Techniques; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000175:diagnosis*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014481:United States; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000601:surgery
keywords: Conventional reconstruction; Face transplantation; Psychosocial outcomes; Screening; Self-inflicted gunshot wound; Vascularized composite allotransplantation