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Case Reports
. 2013 Feb;131(2):241-251.
doi: 10.1097/PRS.0b013e3182789d38.

Total face, double jaw, and tongue transplantation: an evolutionary concept

Amir H Dorafshar  1 , Branko Bojovic, Michael R Christy, Daniel E Borsuk, Nicholas T Iliff, Emile N Brown, Cynthia K Shaffer, T Nicole Kelley, Debra L Kukuruga, Rolf N Barth, Stephen T Bartlett, Eduardo D Rodriguez
Affiliations
Case Reports

Total face, double jaw, and tongue transplantation: an evolutionary concept

Amir H Dorafshar et al. Plast Reconstr Surg. 2013 Feb.

Abstract

Background: The central face high-energy avulsive injury has been frequently encountered and predictably managed at the R Adams Cowley Shock Trauma Center. However, despite significant surgical advances and multiple surgical procedures, the ultimate outcome continues to reveal an inanimate, insensate, and suboptimal aesthetic result.

Methods: To effectively address this challenging deformity, a comprehensive multidisciplinary approach was devised. The strategy involved the foundation of a basic science laboratory, the cultivation of a supportive institutional clinical environment, the innovative application of technologies, cadaveric simulations, a real-time clinical rehearsal, and an informed and willing recipient who had the characteristic deformity.

Results: After institutional review board and organ procurement organization approval, a total face, double jaw, and tongue transplantation was performed on a 37-year-old man with a central face high-energy avulsive ballistic injury.

Conclusions: This facial transplant represents the most comprehensive transplant performed to date. Through a systematic approach and clinical adherence to fundamental principles of aesthetic surgery, craniofacial surgery, and microsurgery and the innovative application of technologies, restoration of human appearance and function for individuals with a devastating composite disfigurement is now a reality.

Clinical question/level of evidence: Therapeutic, V.

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References

    1. Devauchelle B, Badet L, Lengelé B, et al.. First human face allograft: Early report. Lancet 2006;368:203–209.
    1. Fisher M, Dorafshar A, Bojovic B, Manson PN, Rodriguez ED. The evolution of critical concepts in aesthetic craniofacial microsurgical reconstruction. Plast Reconstr Surg. 2012;130:389–398.
    1. Barth RN, Bluebond-Langner R, Nam A, et al.. Facial subunit composite tissue allografts in nonhuman primates: I. Technical and immunosuppressive requirements for prolonged graft survival. Plast Reconstr Surg. 2009;123:493–501.
    1. Brown EN, Dorafshar AH, Bojovic B, et al.. Total face, double jaw, and tongue transplant simulation: A cadaveric study employing computer-assisted techniques. Plast Reconstr Surg. 2012;130:815–823.
    1. Bojovic B, Dorafshar AH, Brown EN, et al.. Total face, double jaw, and tongue transplant research procurement: An educational model. Plast Reconstr Surg. 2012;130:824–834.

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