face transplant? better than reconstructive therapy? new face?

1. ACIAL ALLOTRANSPLANTATION
Dr. J.RAHUL RAGHAVENDER

2. Facial transplantation is a single, complex operation
intended to transform severely deformed features to near-
normal appearance and function with the use of techniques
that conventional plastic surgery cannot match.
Transplantation could be the best method to reconstruct
the loss of complex specialized tissues such as the lips, nose
and eyelids.

3. A composite tissue allograft (CTA) is a construct made
up skin, muscle, tendon, nerves, bone and blood
vessels from another human being that potentially can
be transplanted to an appropriate recipient.

4. HISTORY
• In 2005, the world's first face transplant was done for
38-year-old Isabelle dinoire , whose face had been
disfigured by the attack of their dog. She was
transplanted as part of the left cheek and nose as well as
chin and lips.
• The first complete facial transplant in the USA was
conducted in March 2011 for the 25-year-old
patient Dallas weine ,his face severely disfigured by
severe burns caused while working in a power line

5. 1 year
2 year
5 year

7. Traditional reconstructive
procedures include maxillofacial
prosthesis, free skin graft,
application of local flaps , tissue
prefabrication, tissue expansion,
and free tissue transfer.
No facial bone framework.
Covers only the wound.

8. A composite tissue allograft
(CTA) is a construct made up
skin, muscle, tendon, nerves,
bone and blood vessels from
another human being that
potentially can be transplanted
to an appropriate recipient.

9. FACE TRANSPLANT CANDIDATE
EVALUATION
• The Cleveland Clinic “FACES” Scoring System :
1) Functional status (SBSSS + KPS)
2) Aesthetic deficit (i.e., aesthetic units)
3) Comorbidities
4) Exposed tissue (i.e., depth)
5) Surgical history/recipient vessel patency
• The FACES scores ranged from 10 (minimum)
to 60 (maximum).

10. INDICATIONS
• Trauma,
• Burns,
• High voltage injury,
• Malignancy or
• Congenital disease or defects

11. PROCEDURE
• The donor and recipient blood groups are matched.
• Under general anaesthesia, the wound of the recipient’s
face is extensively debrided .
• Curettage done for maxillary sinus mucosa.
• First, the right anterior facial vein and then the right
external maxillary artery of the donor are anastomosed
end-to-end to the recipient

12. • 2 hour after the arteries are connected, hyper acute
rejection changes such as erythema or blood stasis are
observed.
• The bones were then fixed with a titanium microplate.
• Finally, the soft tissue of the wound was sutured in
layers.
• The overall operation lasts for 18 to 26 hours.
• To effectively control acute rejection, we adopted
quadruple chemotherapy with tacrolimus, mycophenolate
mofetil, corticosteroids, and humanised IL-2 receptor
monoclonal antibody.

17. ADVANTAGES
• Increases the patient’s quality of life, by having a more normal
appearance and a sense of wholeness.
• Basic functions such as blinking and mouth closure after facial
transplants.
• Less traumatic than “traditional” facial reconstructive surgery
using the patient’s own tissue.
• The analysis of motion recovery showed a rapid and continuous
improvement of muscle function.

18. COMPLICATIONS
• Acute rejection (vascular compromise) and chronic
rejection.
• Lifelong regimen of immunosuppressive drugs.
• Risks of immunosuppression include opportunistic
infections that may be life-threatening and metabolic
disorders such as diabetes, kidney damage, and
lymphoma.

19. An acute rejection 2 year follow up

20. REFERENCES
• Pomahac B, Nowinski D, Diaz-Siso JR, et al. Face transplantation.
Curr Probl Surg 2011;48:293-357.
• Infante-Cossio P, Barrera-Pulido F, Gomez-Cia T et al. Facial
transplantation: A concise update. Med Oral Patol Oral Cir Bucal
2012.
• Hoffmann GO, Kirschner MH, Wagner FD, Land W, Bühren V. First
vascularized knee joint transplantation in man. TX Med 1995;8:467.
• Bjordal K, Kaasa S, Mastekaasa A. Quality of Life in Patients Treated
for Head and Neck Cancer: A Follow-up Study 7 to 11 Years after
Radiotherapy. Int J Radiat Oncol Biol Phys. 1994; 28:847–
856.[PubMed: 8138437]
• Pomahac B, Pribaz J, Eriksson E, Bueno EM, Diaz-Siso R, Rybicki FJ,
Annino DJ, Orgill D,Caterson EJ, Caterson SA, Carty MJ, Chun YS,
Sampson CE, Janis JE, Alam DS, Saavedra A, Molnar JA, Edrich T,
Marty FM, Tullius SG. Three patients with full facial transplantation.
NEJM. 2011 Dec 28.

21. CONCLUSION
• In conclusion, patients who had severe facial
deformities resulting from various injuries, we have
shown that it is feasible to perform face
transplantation with the use of a consistent, complex
protocol.
• As our experiential knowledge in this field increases,
we vouch to modify our principles and protocols
towards optimum patient safety, satisfaction and
functionality.

22. THANK YOU