Facial transplantation

Abstract

The face has functional and aesthetic importance. It represents the most identifiable aspect of an individual's physical being. Its role in a person's identity and ability to communicate can therefore not be overstated. The face also plays an important role in certain functional needs such as speech, communicative competence, eye protection, and emotional expressiveness. The latter function bears significant social and psychological import, because two thirds of our communication takes place through nonverbal facial expressions. Accordingly, the significance of reconstruction of the face is indisputable. Yet despite application of meticulous techniques and the development of innovative approaches, full functional and aesthetic reconstruction of the face remains challenging. This is because optimal reconstruction of specialized units of the face have to address both the functional and aesthetic roles of the face.

Keywords: Facial transplantation; allotransplantation; bioethics; reconstructive surgery.

Figure 1

The hemifacial allograft transplantation model. (A) Preoperative view of the donor LBN rat showing markings of the facial skin flap. (B) Hemifacial-scalp flaps including the external ear and scalp, based on the common carotid artery and external jugular vein, were harvested from the donors. (C) Immediate posttransplant view of the hemiface allograft recipient. Transplantation was performed between semi-allogeneic LBN (RT11 + n) donors and Lewis (RT11) recipients. (D) The appearance of the semi-allogenic hemifacial allograft transplants under low dose CsA monotherapy at the 200th day after transplant shows no signs of rejection.

Figure 2

Harvested total facial-scalp flap. (A) The outer aspect of the harvested entire face and scalp flap including the external ears based on the external carotid arteries and external jugular veins. Methylene blue injection on the right side of the flap showed vascular territories. (B) Close view of the inner aspect of the facial-scalp flap (methylene blue injection on the right side of the flap shows vascular territories).

Figure 3

Evaluation of identity transfer after mock transplantation. (A) Appearance of the donor facial-scalp flap before harvesting. (B) When donor flap was harvested and mounted on the artificial head models serving as the recipients, the donor flap assumed the appearance of the recipient's head model.

Figure 4

Coronal-posterior approach for face/scalp flap harvesting. (A) Appearance of the mental nerve before osteotomy. (B) The mental nerves' lengths were extended into the inferior alveolar neurovascular bundle utilizing a sagittal split ramus osteotomy.