Background
Facial allotransplantation provides a unique opportunity to restore facial form and function in severely disfigured patients. Using a single unilateral facial artery for vascularization can significantly reduce surgical duration and thus facilitate the practice of face transplantation.
Patient and methods
A 33-year-old man with a history of high-energy ballistic trauma received a facial allograft comprising the lower 2-thirds of the face, including maxilla and mandible. Vascular anastomoses involved one unilateral facial artery and 2 veins. Vascularization patterns, airway volume and facial functions were assessed before and 1 y after transplantation. In addition, immunosuppressive therapy and rejection episodes were recorded.
Results
One year after transplantation the facial allograft is well perfused and gradually improving in function. Unilateral facial artery anastomosis remains patent and collateralization with the contralateral side is taking place through collaterals of the submental arteries. Bony perfusion of the maxilla and mandible is provided periosteally. Bilateral venous outflow is well opacified. Airway volume is significanly increased with respect to before transplant, and gastrostomy and tracheostomy tubes have been securely removed. The recipient has gained the abilities to smell, speak, feel and grimace 1 y after transplantation. Steroids were securely withdrawn after 9 months leaving the patient on dual immunosuppressive therapy with tacrolimus and mycophenolate mofetil. Two rejection episodes occurred, of which one was treated by steroid pulse and the other by adjusting the maintenance therapy.
Conclusions
A facial allograft comprising the lower 2-thirds of the face including maxilla and mandible is sufficiently perfused by one unilateral facial artery. Bilateral venous outflow, however, seems to be necessary. Facial allotransplantation can significantly and securely improve facial form and function.