Monday, December 7, 2009

The Technical and Anatomical Aspects of the World's First Near-Total Human Face and Maxilla Transplant—an Article Review

The stated objective of the article (full reference below) is simply to “discuss the technical and anatomical analysis and design of an osteocutaneous allograft transplant incorporating the donor maxilla and the execution of the operative protocol during the transplant.” I think they did an excellent job.

As you may recall, Cleveland Clinic did it’s first face transplant in December 9, 2008. It was a combined face and maxilla transplant done as a salvage operation. The patient was a 46-year-old woman with a history of a gunshot wound to the midface who had had 23 major reconstructive procedures prior to the face transplant. (photo credit)

The article includes some nice photos and illustrations along with an abbreviated list of the major anatomical deficits, preoperative planning, the operative protocol, and a discussion of how she has done since surgery. Anyone with an interest in facial reconstruction &/or transplantation surgery will find this article worth reading.

Their conclusion comment:

The concept of facial transplantation has become a reality with 7 successful procedures at the time of this report. With many other institutions interested in performing this procedure, the number of cases will likely increase in the future, and if the promising initial results continue, the operation may become standard of care for extensive facial injuries.

………... The importance of transferring facial bone to incorporate important facial ligaments and prevent ptosis of the donor flap is an important anatomical concept that is becoming clear as the initial transplant cases are followed up further from their surgery. These patients have needed suspension and/or lift revisions to keep the facial tissues elevated. The need for these procedures may be greatly obviated by including the bony attachments of the cutaneous ligaments. On the basis of our findings, we believe that this may be feasible with the facial arterial arcade alone.

………. This raises the important potential role of facial transplant as a salvage procedure in cases in which other options are unavailable and/or suboptimal. As with any novel surgical innovation, information gathered in the nascent stages of the procedure will be vital to define the indications and appropriate patient selection. Our findings will hopefully contribute to this active discussion.

REFERENCE

The Technical and Anatomical Aspects of the World's First Near-Total Human Face and Maxilla Transplant; Arch Facial Plast Surg. 2009;11(6):369-377; Daniel S. Alam, MD; Frank Papay, MD; Risal Djohan, MD; Steven Bernard, MD; Robert Lohman, MD; Chad R. Gordon, DO; Mark Hendrickson, MD; Maria Siemionow, MD, PhD, DSc

The First Composite Face and Maxilla Transplant; JAMA. 2009;302(20):2250-2251; Wayne F. Larrabee; Peter A. Hilger

2 comments:

Anonymous said...

Looking at the "after" pictures, it's utterly amazing what a huge difference there is! As a lay person, what I see of plastic surgery is ads and TV's focus on breast implants, but this sort of work makes it seem vital and wonderful in a way those don't.

gillies said...

I was lucky enough to see presented some of the results from the Harvard/B&W transplant which recently was successfully completed. On video, It gave me emotional chills when the surgeons removed the first arterial clip following the carotid anastomosis. One could see color and life returning to the cold face. It was a beautiful reminder of what plastic and reconstructive surgery is capable of.