Face Transplant: Indications, Outcomes, and Ethical Issues-Where Do We Stand?

Abstract

Background: The addition of face allotransplantation (FT) to the head and neck reconstructive surgery arsenal has started a true revolution. This study is aimed at providing an extensive analysis of the current practice of composite tissue allotransplantation. Moreover, a thorough description of pre-procedural, intra-operative, and post-procedural settings, indications, contraindications, outcomes, ethical considerations, and future perspectives is provided. Methods: The authors’ experience was supplemented with a literature review performed by using the PubMed, MEDLINE, and Embase databases on 21 February 2022. The search terms used were “face transplantation indications”, “face transplantation complications”, and “face transplantation ethical issues”. Results: The most recent achievements and long-term clinical sequelae of FT are classified and summarized. A large number of records (4435) were identified. Seventy-five articles were assessed for eligibility. Publications without new data and reports with a patient follow-up < 5 years were excluded. Nineteen articles met the criteria for inclusion. Conclusions: The most recent achievements in the field of FT may be combined with cutting-edge regenerative medicine procedures and innovative immunological processing. It is paramount to build strong international networks between the world FT experts in order to achieve higher-level outcomes and reduce the complication rate. Nevertheless, the utmost caution is required in patient selection, clinical assessment, strict follow-up, and rejection management.

Keywords: chronic rejection; decellularization; ethics; face transplantation; face transplantation outcomes; facial allotransplantation; facial disfigurement; regenerative medicine; vascularized composite tissue allotransplantation.

Figure 1

This diagram shows the flow of information through the different phases of this review.

Figure 2

Facial tissue defect classification system schematized by the authors for facial transplantation. Soft-tissue defects (above) and skeletal tissue defects (below).

Figure 3

Some representative changes that can occur in FT patients, especially in those who have faced multiple acute rejection episodes. We noted, especially in patients who faced multiple acute rejection episodes, a lymphedematous aspect, sagging, asymmetry, loss of laxity, and pigmentation changes in the transplanted area.