title: Nasal Unit Transplantation: A Cadaveric Anatomical Feasibility Study.
abstract: BackgroundThe science and technical acumen in the field of vascularized composite allotransplantation has progressed rapidly over the past 15 years, and transplantation of specialized units of the face, such as the nose, appears possible. No study to date has evaluated the technical feasibility of isolated nasal unit transplantation (NUT). In this study, we explore the anatomy and technical specifics of NUT.MethodsIn this study, four fresh cadaver heads were studied. Bilateral vascular pedicle dissections were performed in each cadaver. The facial artery was cannulated and injected with food dye under physiologic pressure in two cadavers, and with lead oxide mixture in two cadavers to evaluate perfusion territories supplied by each vascular pedicle.ResultsThe facial artery and vein were found to be adequate pedicles for NUT. Divergent courses of the vein and artery were consistently identified, which made for a bulky pedicle with necessary inclusion of large amounts of subcutaneous tissue. In all cases, the artery remained superficial, while the vein coursed in a deeper plane, and demonstrated consistent anastomoses with the superior transverse orbital arcade. While zinc oxide injection of the facial artery demonstrated filling of the nasal vasculature across the midline, dye perfusion studies suggested that unilateral arterial inflow may be insufficient to perfuse contralateral NUT components. Discrepancies in these two studies underscore the limitations of nondynamic assessment of nutritive perfusion.ConclusionNUT based on the facial artery and facial vein is technically feasible. Angiosome evaluation suggests that bilateral pedicle anastomoses may be required to ensure optimal perfusion.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Dorafshar
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Gerhard S
authors.initials: GS
authors.lastname: Mundinger
authors.affiliation: Division of Plastic Surgery, Saint Joseph Hospital, Chicago, Illinois.
authors.forename: Brent
authors.initials: B
authors.lastname: Robinson
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Sami
authors.initials: S
authors.lastname: Tuffaha
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.affiliation: Division of Facial Plastic Surgery, Department of Otolaryngology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Byrne
authors.affiliation: Division of Plastic Surgery, Saint Joseph Hospital, Chicago, Illinois.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Walton
mesh_terms: D002102:Cadaver; D003287:Contrast Media; D005240:Feasibility Studies; D006801:Humans; D007854:Lead; D009666:Nose / Q000033:anatomy & histology / Q000098:blood supply / Q000637:transplantation*; D010087:Oxides; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D063986:Vascularized Composite Allotransplantation / Q000379:methods
chemical_list: D003287:Contrast Media; D010087:Oxides; D007854:Lead; C047365:lead oxide