Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 May;137(5):1569-1581.
doi: 10.1097/PRS.0000000000002122.

Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation: The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles

Michael Sosin  1   2 , Daniel J Ceradini  1   2 , Alexes Hazen  1   2 , Jamie P Levine  1   2 , David A Staffenberg  1   2 , Pierre B Saadeh  1   2 , Roberto L Flores  1   2 , Lawrence E Brecht  1   2 , G Leslie Bernstein  1   2 , Eduardo D Rodriguez  1   2
Affiliations

Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation: The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles

Michael Sosin et al. Plast Reconstr Surg. 2016 May.

Abstract

Background: The application of aesthetic, craniofacial, and microsurgical principles in the execution of face transplantation may improve outcomes. Optimal soft-tissue face transplantation can be achieved by incorporating subunit facial skeletal replacement and subsequent tissue resuspension. The purpose of this study was to establish a reconstructive solution for a full face and scalp burn and to evaluate outcome precision and consistency.

Methods: Seven mock face transplants (14 cadavers) were completed in the span of 1 year. Components of the vascularized composite allograft included the eyelids, nose, lips, facial muscles, oral mucosa, total scalp, and ears; and skeletal subunits of the zygoma, nasal bone, and genial segment. Virtual surgical planning was used for osteotomy selection, and to evaluate postoperative precision of hard- and soft-tissue elements.

Results: Each transplant experience decreased each subsequent transplant surgical time. Prefabricated cutting guides facilitated a faster dissection of both donor and recipient tissue, requiring minimal alteration to the allograft for proper fixation of bony segments during inset. Regardless of donor-to-recipient size discrepancy, ample soft tissue was available to achieve tension-free allograft inset. Differences between virtual transplant simulation and posttransplant measurements were minimal or insignificant, supporting replicable and precise outcomes.

Conclusions: This facial transplant model was designed to optimize reconstruction of extensive soft-tissue defects of the craniofacial region representative of electrical, thermal, and chemical burns, by incorporating skeletal subunits within the allograft. The implementation of aesthetic, craniofacial, and microsurgical principles and computer-assisted technology improves surgical precision, decreases operative time, and may optimize function.

PubMed Disclaimer

References

    1. Sarwer DB, Ritter S, Reiser K, et al. Attitudes toward vascularized composite allotransplantation of the hands and face in an urban population. Vasc Compos Allotransplant. 2014;1:2230.
    1. Brown EN, Dorafshar AH, Bojovic B, et al. Total face, double jaw, and tongue transplant simulation: A cadaveric study using computer-assisted techniques. Plast Reconstr Surg. 2012;130:815823.
    1. Brazio PS, Barth RN, Bojovic B, et al. Algorithm for total face and multiorgan procurement from a brain-dead donor. Am J Transplant. 2013;13:27432749.
    1. Gateno J, Xia JJ, Teichgraeber JF. New 3-dimensional cephalometric analysis for orthognathic surgery. J Oral Maxillofac Surg. 2011;69:606622.
    1. Dorafshar AH, Brazio PS, Mundinger GS, Mohan R, Brown EN, Rodriguez ED. Found in space: Computer-assisted orthognathic alignment of a total face allograft in six degrees of freedom. J Oral Maxillofac Surg. 2014;72:17881800.

MeSH terms

LinkOut - more resources