Principles and Techniques for Facial Allotransplantation

Abstract

For simple cases requiring facial rehabilitation, conventional reconstructive procedures may achieve good results. However, more complex situations may require numerous staged surgical procedures to obtain acceptable outcomes. In these cases, there are great obstacles to the proper restoration of shape and function. Only 29 facial transplantations (Khalifian et al., Lancet:1–11, 2014) have been performed worldwide over the past 9 years—not only because of the complexity of the procedure but also because of the required lifelong immunological regimen for organ transplantation. Nevertheless, in terms of results, this procedure should be considered for patients with major disfigurement due to severe trauma, benign malformation, or tumor. For some specific indications, single-stage vascularized composite allotransplantation (VCA) may provide a solution to restoring both aesthetics and function in a disfigured patient. Facial VCA requires a multidisciplinary approach (Bueno et al., J Plast Reconstr Aesthet Surg 64(12):1572–9, 2011). This chapter discusses the surgical procedures for both recipient and donor, including indications for a facial transplantation, planning and management of the VCA approach, immunological conditions and monitoring, psychological and ethical concerns, follow-up, and complications.