Face Transplantation: Clinical Application of the Concept

• Authors: Maria Siemionow , Mikaël Hivelin
• Languages of publication: EN

Abstracts

EN

The face allotransplantation is a unique procedure, requiring a lifetime immunosuppressive therapy, and as such brings an ethical debate among medical societies and general public. The indications for this procedure have to be considered when the classic reconstructive procedures failed, and the patients are left with debilitating defects precluding them from normal social life.The transplantation protocol must be approved and registered by the institutional review board and health agencies. It is crucial that a thorough assessment of the patient for each indication will be performed by a multidisciplinary team and panel of experts in the field of plastic and reconstructive surgery, maxillo facial surgery, immunology of transplantations and psychiatry. The thorough psychiatric and psychological evaluation of potential candidates is mandatory, as well as evaluation by ethic experts.Numerous experimental models and extensive anatomical studies in cadaver model lead to the clinical success of face transplantation, raising a complex ethical question despite the fact that it is an important progress in plastic and reconstructive surgery.Three face transplantations have been performed since 2005. The transplants differed and were tailored, to match the extend of each patient facial defect.In this article we present the clinical cases of face transplantation based on our experience and dissections studies and a literature review.

Keywords

EN

face transplantation; composite tissue allotransplantation; cell therapy; skin rejection; tolerance induction; chimerism; immunosuppression; bone marrow transplantation

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2008
• Volume: 80
• Issue: 10
• Pages: 571-578

Dates

published

1 - 10 - 2008

online

20 - 10 - 2008

Contributors

author

Maria Siemionow

• Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA

author

Mikaël Hivelin

• Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA

References

• Devauchelle B, Badet L, Lengele B, et al. First human face allograft: early report. Lancet 2006; 368(9531): 203-09.
• Benateau H, Riscala S, Labbe D, et al. Gunshot wounds to the face. A proposed classification. Rev Stomatol Chir Maxillofac 2001; 102(2): 129-32.[PubMed]
• Giessler GA, Cornelius CP, Suominen S, et al. Primary and secondary procedures in functional and aesthetic reconstruction of noma-associated complex central facial defects. Plast Reconstr Surg 2007; 120(1): 134-43.[WoS]
• Abramson DL, Vander Woude DL, Orgill DP, et al. Traumatic avulsion and reconstruction of the midface. J Craniomaxillofac Trauma 1996; 2(1): 61-64.
• Parrett BM, Pomahac B, Orgill DP, et al. The role of free-tissue transfer for head and neck burn reconstruction. Plast Reconstr Surg 2007; 120(7): 1871-78.
• Angrigiani C, Grilli D. Total face reconstruction with one free flap. Plast Reconstr Surg 1997; 99(6): 1566-75.
• Abramson DL, Pribaz JJ, Orgill DP. The use of free tissue transfer in burn reconstruction. J Burn Care Rehabil 1996; 17(5): 402-08.[Crossref][PubMed]
• Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head and neck: a 10-year experience. Plast Reconstr Surg 1999; 103(3): 808-20.
• Pribaz JJ, Fine NA. Prefabricated and prelaminated flaps for head and neck reconstruction. Clin Plast Surg 2001; 28(2): 261-72, vii.
• Lantieri L, Wolkenstein P. Cutaneous manifestations of type 1 neurofibromatosis and their treatment. Ann Chir Plast Esthet 1998; 43(4): 445-54.[PubMed]
• Jiang HQ, Wang Y, Hu XB, et al. Composite tissue allograft transplantation of cephalocervical skin flap and two ears. Plast Reconstr Surg 2005; 115(3): 31e-35e.
• Paraskevas A, Ingallina F, Meningaud JP, et al. Face allotransplantation: anatomical study, potential partial and total facial allografts harvesting and clinical application. Ann Chir Plast Esthet 2007; 52(5): 485-93.[WoS][PubMed][Crossref]
• Siemionow M, Papay F, Kulahci Y, et al. Coronal-posterior approach for face/scalp flap harvesting in preparation for face transplantation. J Reconstr Microsurg 2006; 22(6): 399-405.[Crossref]
• Siemionow M, Agaoglu G. The issue of "facial appearance and identity transfer" after mock transplantation: a cadaver study in preparation for facial allograft transplantation in humans. J Reconstr Microsurg 2006; 22(5): 329-34.[PubMed][Crossref]
• Siemionow M, Agaoglu G, Unal S. A cadaver study in preparation for facial allograft transplantation in humans: part II. Mock facial transplantation. Plast Reconstr Surg 2006; 117(3): 876-85.
• Siemionow M, Unal S, Agaoglu G, et al. A cadaver study in preparation for facial allograft transplantation in humans: part I. What are alternative sources for total facial defect coverage? Plast Reconstr Surg 2006; 117(3): 864-72.
• Demir Y, Ozmen S, Klimczak A, et al. Tolerance induction in composite facial allograft transplantation in the rat model. Plast Reconstr Surg 2004; 114(7): 1790-1801.
• Siemionow M, Demir Y, Mukherjee A, et al. Development and maintenance of donor-specific chimerism in semi-allogenic and fully major histocompatibility complex mismatched facial allograft transplants. Transplantation 2005; 79(5): 558-67.[Crossref]
• Siemionow MZ, Demir Y, Sari A, et al. Facial tissue allograft transplantation. Transplant Proc 2005; 37(1): 201-04.[Crossref]
• Cosimi AB, Sachs DH. Mixed chimerism and transplantation tolerance. Transplantation 2004; 77(6): 943-46.
• Pascual M, Tolkoff-Rubin N, Farrell ML, et al. The kidney transplant program at the Massachusetts general hospital. Clin Transpl 2001; 123-30.[PubMed]
• Ashjian P, Chen CM, Pusic A, et al. The effect of postoperative anticoagulation on microvascular thrombosis. Ann Plast Surg 2007; 59(1): 36-39.[WoS]
• Kanitakis J, Badet L, Petruzzo P, et al. Clinicopathologic monitoring of the skin and oral mucosa of the first human face allograft: Report on the first eight months. Transplantation 2006; 82(12): 1610-15.

Identifiers

DOI

10.2478/v10035-008-0079-1