Facial Transplantation: Complications, Outcomes, and Long-Term Management Strategies

Abstract

Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.

Keywords: composite tissue allotransplantation; ethics; facial transplantation; immunosuppression; microvascular surgery.

Fig. 1

Left: recipient eyelid tissue prior to face transplantation. Middle: eyelid in procured facial allograft with subsequent tarsorrhaphy of the superior and inferior tarsal plates. Right: allograft following inset to recipient. (Reproduced with permission of Grigos et al. 42 )

Fig. 2

( A ) Progression of face vascularized composite allografts for up to an 8-year interval showing changes associated with chronic rejection. ( B ) White patches on allograft with permanent telangiectasias in one of the face vascularized composite allograft recipients: physical manifestations of chronic rejection. (Reproduced with permission of Krezdorn et al. 69 )