Full Face Transplant: The First Case Report

Juan P. Barret, MD, PhD; Joan Gavaldà, MD, PhD; Javier Bueno, MD, PhD; Xavier Nuvials, MD; Teresa Pont, MD; Nuria Masnou, MD; Maria J. Colomina, MD; Jordi Serracanta, MD; Anna Arno, MD; Pere Huguet, MD; Jose M. Collado, MD; Pere Salamero, MD; Carlos Moreno, RN; Roser Deulofeu, MD; Vicenç Martínez-Ibáñez, MD, PhD

Disclosures

Annals of Surgery. 2011;254(2):252-256. 

In This Article

Abstract and Introduction

Abstract

Background: Since 2005, 11 human face transplants have been performed. In each, varying amounts of tissue have been transplanted. Herein we report a "full" face transplant including all intact aesthetic and functional units.
Methods: On March 27, 2010, we performed a full face transplant, including all the soft tissues and part of the underlaying bony structure, at the University Hospital Vall d'Hebron, Barcelona, Spain. The donor was a 41-year-old male, who died from a massive brain hemorrhage. The recipient was a 30-year-old male with a severe facial deformity caused by a ballistic trauma in 2005. Harvest and subsequent implant took 24 hours. The patient received initial induction (Thymoglobulin 2 mg/kg/iv; Prednisone 1 gm/iv) and maintenance (Prednisone 1 mg/kg/24hours, Tacrolimus 10–15 ng/mL/PO, and Mycophenolate mofetil 2g/daily/PO) immunosuppression and Infection prophylaxis (Valganciclovir and Co-trimoxazole).
Results: There were no intraoperative complications. Postoperative complications included; venous anastomoses thrombosis, acute oro-cutaneous fistula, right parotid sialocele and 2 acute rejection episodes, which were resolved by revision of the anastomosis, profuse irrigation and immunotherapy adjustment, respectively. The patient was discharged from the hospital at 4 months posttransplant with; near-total sensation and partial-motor recovery, no psychological complications and excellent acceptance of his new facial appearance.
Conclusions: The early success described in this case report demonstrates the technical and clinical feasibility of transplanting all the tissues of the with all its aesthetic and functional units intact.

Introduction

Composite tissue allotransplantation (CTA) became a clinical reality in 1998 when the first successful human hand transplant was performed in Lyon, France.[1] This was made possible when a team in Louisville, USA demonstrated long-term CTA survival, in a pre-clinical swine model, using triple immunosuppression therapy.[2] Seven years later, after several successful hand transplants and surrounded by intense ethical debate[3–5] the first human facial composite tissue allotransplantation (FCTA) was performed in Amiens, France.[6] As in the first hand transplants, the first FCTA was also successful, restoring excellent appearance, function, and quality-of-life to the patient.[6,7]

To date 11 FCTAs have been performed. In each, varying amounts of facial tissue were transplanted, depending on the defect reconstructed.[8–11] In contrast to the previously reported FCTAs, here, for the first time, we report a "full" FCTA that includes the entire face with all its aesthetic and functional units (forehead, nose, eyelids, cheeks, lips, and chin). In a recent publication, Lengele proposed a classification for FCTAs based on the amount and type of tissue transplanted.[12] Based on his classification the case we present here is a Type V facial allograft (Table 1).

The introduction of all new treatments, brings with it many scientific, clinical, technical "surgical" and ethical questions and challenges. The primary questions and challenges addressed in this case report are related to the technical or surgical technique required to successfully harvest and transplant such a large and complex combination of aesthetic and functional facial units. In this case report we describe the surgical procedure and initial outcomes of the first full FCTA performed on March 27, 2010, in Barcelona, Spain.[13]

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