Trasplante facial generalidades / Facial trasplant generalities

Resumen El trasplante facial es un alotrasplante compuesto vascularizado que busca la reconstrucción de defectos masivos faciales permitiendo la reinserción social del receptor, generando un impacto positivo sobre su calidad de vida. El objetivo de este artículo fue realizar una revisión de la literatura sobre generalidades del trasplante facial, enfocándose en los cuidados pre, intra y postoperatorios concernientes a la temática. La búsqueda bibliográfica se realizó desde el 13 de septiembre del 2018 hasta el 31 de marzo del 2019 utilizando los términos MESH "Face Transplant" y "Face Transplantation". Aplicando los criterios de inclusión y exclusión se obtuvieron 43 artículos sobre los cuales se desarrolló la revisión. El trasplante facial es un procedimiento nuevo en el cual hay muchas áreas por explorar, sin embargo, es una alternativa prometedora a los métodos utilizados para la reconstrucción de lesiones faciales complejas, que se optimizará a medida que se extienda su uso. MÉD.UIS.2020;33(3): 29-36

Abstract The facial transplant is a vascularized compound allogeneic transplant that seeks the reconstruction of massive facial defects allowing the social reintegration of the recipient, generating a positive impact on their quality of life. The objective of this article was to review the literature on generalities of facial transplantation, focusing on the pre, intra and postoperative care regarding the subject. The bibliographic search was performed from September 13, 2018 to March 31, 2019 using the MESH terms "Face Transplant" and "Face Transplantation". Applying the inclusion and exclusion criteria, 43 articles were obtained on which the review was developed. Facial transplantation is a new procedure in which there are many areas to explore, however, it is a promising alternative to the methods used for the reconstruction of complex facial injuries, which will be optimized as its use expands. MÉD.UIS.2020;33(3): 29-36

Analysis of factors involved in brain-death donor processing for face transplantation in Korea: How much time is available from brain death to transplantation?

BACKGROUND: Face transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process. METHODS: A retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs. RESULTS: The patient base (n=1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (±15.3). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (±14 hours 50 minutes) and 22 hours 57 minutes (±16 hours 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%). CONCLUSIONS: When face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.

Análise bioética do transplante de face no Brasil / Bioethical analysis of face transplantation in Brazil

INTRODUÇÃO: Atualização sobre os aspectos bioéticos do transplante facial. Estudo de revisão da literatura sobre a situação atual dos transplantes de órgãos e de face, a importância da face humana, e a face humana como órgão vital. MÉTODOS: Revisão bibliográfica narrativa com análise documental acerca dos transplantes de face nos últimos 10 anos. RESULTADOS: Na base de dados PubMed foram encontradas 8259 publicações com a palavra-chave em face transplantation, face transplantation and bioethics em 28 artigos e em organ transplant ethics em em 4877 publicações; documentos relacionados à legislação encontrados na ABTO (Associação Brasileira de Transplantes de Órgãos). CONCLUSÃO: A experiência dos países com o transplante de face demonstrou que é uma opção viável para reconstrução de graves lesões faciais, entretanto, é considerado um procedimento experimental com alto risco de complicações, altos custos, envolve equipe multidisciplinar e a necessidade do uso vitalício de imunossupressores. Até o momento, é indicado para um pequeno grupo de pacientes. Do ponto de vista bioético, vale contextualizar que, apesar da obtenção do termo de consentimento, é necessário avaliar qual é o nível de risco aceitável para o participante da pesquisa. Quem será o responsável pelos custos relacionados ao procedimento? Quando os recursos públicos podem ser utilizados para justificar os direitos individuais em detrimento dos direitos públicos?

INTRODUCTION: This update on bioethical aspects of face transplantation reviews the literature on the current status of organ and face transplantation, the significance of the human face, and the human face as a vital organ. METHODS: This was a narrative bibliographic review, with documentary analysis of face transplantation in the last 10 years. RESULTS: A search of the PubMed database identified 8,259 papers with the keyword face transplantation, 28 articles with the keywords face transplantation and bioethics, and 4,877 papers with the keyword organ transplant ethics; documents related to legislation were found in the Brazilian Association of Organ Transplantation (Associação Brasileira de Transplantes de Órgãos - ABTO). CONCLUSION: The experience of countries where face transplantation has been performed has shown that this is a viable option for the reconstruction of severe facial lesions. However, face transplantation is considered an experimental procedure with high risk of complications and costs, and requires a multidisciplinary team and the lifetime use of immunosuppressants. To date, this procedure is only indicated for a small group of patients. From a bioethics standpoint, it should be noted that, despite providing consent, the level of risk acceptable to the recipient must be assessed. Who will be responsible for the costs related to the procedure? When can public resources be used to justify individual rights over public rights?

Uso de cuero cabelludo como zona donadora de injertos cutáneos de espesor parcial / Use of the scalp as a donor area for partial thickness skin grafts

Objetivo: Demostrar los beneficios del uso de cuero cabelludo como área donadora de injertos cutáneos de espesor parcial. Método: Estudio retrospectivo descriptivo realizado de 2013 a 2015 en la Unidad de quemaduras pediátricas del hospital Roosevelt de 111 pacientes en que se utilizaron injertos del cuero cabelludo. Resultados: La mayoría de los pacientes sufrieron quemaduras por inmersión en líquidos calientes con disponibilidad limitada de zonas donadoras de injertos. El otro uso que se le dio a los injertos de cuero cabelludo fue en quemaduras y lesiones faciales debido a la similitud de la pigmentación de estas áreas. Este estudió demostró el corto tempo de epitelización de esta zona donadora (3.5 días), lo que permitió que se utilizara en varias ocasiones. La principal complicación fue la alopecia (1.8%) resultado de una toma de un injerto muy grueso. Conclusión: El estudio sugiere que el cuero cabelludo es una zona donadora útil cuando las principales áreas donadoras están limitadas. Más investigación tendrá que realizarse para establecer otros beneficios observados del uso de esta región como zona donadora de injertos cutáneos.

Objectve: Demonstrate the benefts of using scalp as a donor area of partal split thickness skin grafs. Methods: Retrospectve descriptve study from 2013 to 2015 shows 111 patents that required a skin graf from the scalp in a pediatric burn unit. Results: Most of the patents were burn victms, but few other cases are described as well. The most common use of this donor area was for patents that had sufered pot immersion scalds where the back, gluteus and lower limbs were afected and no longer available as skin donor areas. The other main use was in facial burns and traumas, because the color similitude between the face and scalp renders a beter cosmetc result of facial skin grafs. This study demonstrates the short period of healing (3.5 days) of the donor area making possible its reuse in a shorter period of tme. The main complicaton was alopecia (1.8%) where the graf take was too deep. Conclusions: The study suggests the use of scalp donor area when other main donor areas are not available and for facial burns. Further studies should be performed in order to establish other observed benefts of the scalp as a donor area for split thickness skin grafs.

Facial Transplantation Surgery Introduction

Severely disfiguring facial injuries can have a devastating impact on the patient's quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie "Face/Off" have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea.

Face transplantation in rats. Reproducibility of the experimental model in Brazil

PURPOSE: To investigate the reproducibility of the experimental model of face allotransplantation in rats in Brazil. METHODS: Eighteen rats were operated, nine-nine donors recipients. Animals underwent transplantation of the left hemiface, with periorbital and scalp. Transplants were made from donor Wistar rats to recipients Lewis rats. Flaps were based on the common carotid artery and the external jugular vein of the donor animal and the anastomosis in the recipient area was performed in common carotid artery (end-to-side) and in external jugular vein (end-to-end). RESULTS: Of the nine recipient animals operated, six survived and three progressed to death in the first days after surgery (survival rate = 67%). The mean time of the procedure was 252 minutes and the mean time of flap ischemia was 95 minutes. The five surviving animals were sacrificed at 14 days, in good general condition and without signs of tissue rejection. CONCLUSIONS: The experimental model of face allotransplantation in rats is reproducible in our midst. Duration of surgery, time of flap ischemia, animal survival rate and complications observed were similar to those described in the literature. .

Enxerto dermogorduroso para tratamento da atrofia hemifacial progressiva / Dermis-fat Graft for Treatment of the Progressive Hemifacial Atrophy

A atrofia hemifacial progressiva (síndrome de Parry-Romberg) é uma doença rara, de etiologia desconhecida, caracterizada por atrofia facial unilateral, que afeta pele, subcutâneo, músculo e, raramente, estruturas osteocartilaginosas. As deformidades faciais, causadas pela doença, causam transtornos psicológicos e sociais aos pacientes acometidos. O tratamento consiste na correção dessas deformidades por meio da reposição de tecido que foi perdido em função da atrofia. Preenchimento com enxertos dérmico, gorduroso, cartilaginoso ou ósseo, injeção de silicone ou próteses de acrílico são alternativas sugeridas para correção da atrofia facial. O objetivo deste estudo é relatar um caso de atrofia hemifacial progressiva, tratada com enxerto dermogorduroso e demonstrar que essa manobra cirúrgica pode melhorar o aspecto estético da face do paciente com base na discussão dos aspectos terapêuticos dessa desordem... (AU)

The progressive hemifacial atrophy (Parry-Romberg syndrome) is a rare disease of unknown etiology characterized by unilateral facial atrophy that affects skin, subcutaneous tissue, muscle, and rarely osteocartilaginous structures. Facial deformities caused by the disease cause social and psychological problems to affected patients. Treatment consists of correction of these deformities by replacing tissue that has been lost due to atrophy. Fill with grafts of dermal, fat, cartilage or bone, injection of silicone or acrylic prostheses are alternatives suggested to correct the facial atrophy. The aim of this study is to report a case of progressive hemifacial atrophy treated with dermis-fat graft and demonstrate that this surgical procedure may improve the aesthetic appearance of the patient's face and discuss the therapeutic aspects of this disorder... (AU)

Facial Transplantation Surgery

No abstract available.

Hemifacial Transplantation Model in Rats

BACKGROUND: To refine facial transplantation techniques and achieve sound results, it is essential to develop a suitable animal model. Rat is a small animal and has many advantages over other animals that have been used as transplantation models. The purpose of this study was to describe a rat hemifacial transplantation model and to verify its convenience and reproducibility. METHODS: Animals used in this study were Lewis rats (recipients) and Lewis-Brown Norway rats (donors). Nine transplantations were performed, requiring 18 animals. The hemifacial flap that included the ipsilateral ear was harvested based on the unilateral common carotid artery and external jugular vein and was transferred as a single unit. Cyclosporine A therapy was initiated 24 hours after transplantation and lasted for 2 weeks. Signs of rejection responses were evaluated daily. RESULTS: The mean transplantation time was 1 hour 20 minutes. The anatomy of common carotid artery and external jugular vein was consistent, and the vessel size was appropriate for anastomosis. Six of nine allografts remained good viable without vascular problems at the conclusion of study (postoperative 2 weeks). CONCLUSION: The rat hemifacial transplantation model is suitable as a standard transplantation training model.

Hemifacial Transplantation Model in Rats

BACKGROUND: To refine facial transplantation techniques and achieve sound results, it is essential to develop a suitable animal model. Rat is a small animal and has many advantages over other animals that have been used as transplantation models. The purpose of this study was to describe a rat hemifacial transplantation model and to verify its convenience and reproducibility. METHODS: Animals used in this study were Lewis rats (recipients) and Lewis-Brown Norway rats (donors). Nine transplantations were performed, requiring 18 animals. The hemifacial flap that included the ipsilateral ear was harvested based on the unilateral common carotid artery and external jugular vein and was transferred as a single unit. Cyclosporine A therapy was initiated 24 hours after transplantation and lasted for 2 weeks. Signs of rejection responses were evaluated daily. RESULTS: The mean transplantation time was 1 hour 20 minutes. The anatomy of common carotid artery and external jugular vein was consistent, and the vessel size was appropriate for anastomosis. Six of nine allografts remained good viable without vascular problems at the conclusion of study (postoperative 2 weeks). CONCLUSION: The rat hemifacial transplantation model is suitable as a standard transplantation training model.

Pasado, presente y futuro del trasplante facial en el mundo y en la Argentina / Past, present and future of facial transplant in the world and in Argentina

El año 2005 marcó un cambio de paradigma en la reconstrucción facial. En Amiens, Francia, se llevó a cabo con éxito el primer trasplante de cara. Desde entonces, se han planteado varios interrogantes; entre ellos el desafío técnico, el manejo inmunológico y el dilema ético. El presente trabajo es una revisión de la literatura publicada hasta la actualidad. Se analiza la historia, implicaciones, resultados hasta hoy y su futuro. Asimismo, se evalúa la situación actual y factibilidad en la Argentina.

Review of Current Facial Allotransplantation and Future Aspects

Current Status of Face Transplantation: Where Do We Stand in Korea?

The world's first face transplantation was performed in France, in 2005. Since then, 21 cases of face transplantation have been performed. Face transplantation is one of the most prominent part of composite tissue allotransplantation (CTA) along with hand transplantation. Since these fields are not deal with life-saving organs, there are many arguments about immunosuppression therapy. Recent paradigm of face transplantation shows that surgical ranges are expanded from partial face transplantation to full face transplantation. Most immunosuppression protocols are triple therapy, which consists of tacrolimus (FK-506), mycophenolate mofetil and prednisolone. Anatomical researches, immunosuppression, and immunotolerance take great parts in the researches of CTA. The medical fields directly related to face transplantation are microsurgery, immunology, and transplantation. Nowadays, each field is performed widely. Therefore people, even medical teams think face transplantation could be easily realized, sooner or later. But there are lots of things that should be prepared for not only practice and immunosuppression therapy but also for the cooperation with relevant fields. That's the reason why only 21 cases of face transplantation have been done, while more than 70 cases of hand transplantation have been done in the past years. Especially in Korea, brain death patients are not enough even for organ transplantation and furthermore there are some troubles in taking part in the society of transplantation. Face transplantation has lots of problems concerning variable medical fields, administration, society, ethics, and laws. Therefore, for the realization of face transplantation in Korea, not only medical skills but also political powers are needed.

Image of Plastic Surgeons and Plastic Surgery Illustrated in Korean Movies and TV Dramas

Nowadays, plastic surgical operations are increasingly being performed in Korea. We have gained added interest in this because some professional pictures contain plastic surgery in their venue. In the films, we intend to see the recognition of society for plastic surgeons and which field of plastic surgery. The list of movies for analysis were 'Plastic Beauty (1975)', 'Penthouse Elephant (2005)', '200 Pounds Beauty (2006)', 'Cinderella (2006)', and 'Time (2006)'. The TV dramas were 'She is looking (2005)', 'Lovers (2006-2007)', and 'Before & After Plastic Surgery Clinic (2008)'. Films were analyzed according to the following: the chief complaints and names of the operations, character of plastic surgeons, result of the operation and its possibility in reality, and its effect of plastic surgery on the life of the patients. Most of the film contained facial transplantation or the change of the face or body different from the original shape. Character type of the plastic surgeons was mostly medical realism, rather than ideal humanism. Most of the plastic surgeons have capability as a doctor; however, some of them had extramarital affairs. The surgery was successful in most of the cases, but were the patients happy with the results? This was not the case in the movies. In only one movie, '200 Pounds Beauty', the patient became happy; rest of them were eminently unhappy with the outcome. Why the discrepancy? It is difficult to analyze the minds of the people in the films, but considering that the majority of the characters in the films were rather unsavory, one may deduce that a crooked mind functions differently. Perhaps it is too much to hope for a day that will come when we will see a film that portrays the mental anguish that accompanies each and every procedure the Korean plastic surgeons make.

Estudio morfométrico de la región orbitaria para la instalación de implantes craneofaciales / Morphometric study of orbital region for craneofacial implant applications

El objetivo de esta investigación es establecer las relaciones morfométricas presentes en las regiones periorbitarias utilizadas para la instalación de implantes craneofaciales. Se diseñó un estudio descriptivo utilizando 40 cráneos humanos de entre 20 y 60 años del Laboratorio de Anatomía del Departamento de Morfología de la Facultad de Odontología de Piracicaba de la Universidad Estadual de Campinas. Fueron realizadas tomografías volumétricas cone beam y a partir de la reconstrucción virtual se precisaron los puntos de análisis, basados en la literatura científica, tanto clínica como anatómica de la región. Se realizaron divisiones de la órbita respetando distancias mínimas y reparos anatómicos como el seno frontal y seno maxilar. En las mediciones realizadas, se observó que el área supraorbitaria presentaba una distancia ósea sagital de 8,14mm +/- 1,91mm, el reborde infraorbitario de 7mm +/- 1,71mm y el área lateral de órbita un promedio de 7,91mm +/- 1,15mm. Considerando que los implantes de mayor dimensión son de 6mm, la instalación de implantes en estas regiones está totalmente asegurada en términos de requerimientos de cantidad ósea regional.

The aim of this research was to study the morphometric relation present in periorbital region, used in the installation of craniofacial implants. A descriptive study was carried out using 40 skulls between 20 and 60 years of age from the Laboratório de Anatomia do Departamento de Morfologia da Facultade de Odontologia de Piracicaba da Universidade Estadual de Campinas. Volumetric tomography with cone beam technique was used along with virtual reconstruction, with the point of analysis being selected based on the clinical and anatomical scientific literature. Orbital division was realized with minimal distance from the frontal and maxillary sinus. During measurement it was observed that the superior orbital rim presented a sagittal bone distance of 8.14mm +/- 1.91 mm; inferior orbital rim of 7mm +/- 1.71 mm, and the lateral orbital presented an average of 7.91 mm +/- 1.15 mm, considering that craniofacial implants present up to 6 mm in length, the installation of implants in this area is considered safe in terms of regional bone quantity requirements.

A New Facial Composite Flap Model(Panorama Facial Flap) with Sensory and Motor Nerve from Cadaver Study for Facial Transplantation

PURPOSE: The purpose of this study was to investigate the possibility that a dynamic facial composite flap with sensory and motor nerves could be made available from donor facial composite tissue. METHODS: The faces of 3 human cadavers were dissected. The authors studied the donor faces to assess which facial composite model would be most practicable. A "panorama facial flap" was excised from each facial skeleton with circumferential incision of the oral mucosa, lower conjunctiva and endonasal mucosa. In addition, the authors measured the available length of the arterial and venous pedicles, and the sensory nerves. In the recipient, the authors evaluated the time required to anastomose the vessels and nerve coaptations, anchor stitches for donor flaps, and skin stitches for closure. RESULTS: In the panorama facial flap, the available anastomosing vessels were the facial artery and vein. The sensory nerves that required anastomoses were the infraorbital nerve and inferior alveolar nerve. The motor nerve requiring anstomoses was the facial nerve. The vascular pedicle of the panorama facial flap is the facial artery and vein. The longest length was 78mm and 48mm respectively. Sensation of the donor facial composite is supplied by the infraorbital nerve and inferior alveolar nerve. Motion of the facial composite is supplied by the facial nerve. Some branches of the facial nerve can be anastomosed, if necessary. CONCLUSION: The most practical facial composite flap would be a mid and lower face flap, and we proposed a panorama facial flap that is designed to incorporate the mid and lower facial skin with and the unique tissue of the lip. The panorama facial composite flap could be considered as one of the practicable basic models for facial allotransplantation.

Evaluation of Reliability and Validity of the Louisville Instrument for Transplantation(LIFT) in Korean Population

PURPOSE: Composite tissue allotransplantation has emerged as a new therapeutic modality to reconstruct major tissue defects of the head, neck and extremities. A questionnaire-based instrument, the Louisville Instrument for Transplantation(LIFT), has been developed to objectively assess the risk-versus-benefit ratio for composite tissue allotransplantation procedures. The objective of this study is to assess if the LIFT is a useful, reliable and valid tool to apply to the Korean population. METHODS: Seventy-three medical students and 60 lay public completed the LIFT questionnaire(translated to Korean) over the period from February 2010 to April 2010. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was analyzed using Pearson's correlation coefficient. Construct validity was assessed by comparing Pearson's correlation coefficients between perceived improvements in quality of life and responses to risk tolerance questions concerning organ transplants. RESULTS: Measurements of the test-retest reliability showed that Pearson's correlation coefficients ranged from 0.241 to 0.902, and Cronbach's alphas ranged from 0.52 to 0.80 for medical students and from 0.63 to 0.83 for the lay public. Pearson's correlation coefficients showed significant correlations between perceived improvements in quality of life and responses to risk tolerance questions concerning organ transplants. Hand transplant showed a significant correlation in medical students. Foot, hand, two hands, larynx, partial face transplants showed significant correlations for the lay public. CONCLUSION: The applicability of the LIFT to the Korean population was found to be reliable and valid. The LIFT may serve as a useful tool for clinical application in the Korean population.

Transplante facial: una realidad clínica / Facial transplantation: a reality

La desfiguración de la cara es una condición devastadora. El transplante facial ha surgido como una nueva alternativa de tratamiento para pacientes con desfiguración severa. Ocho transplantes faciales se han llevado a cabo desde el año 2005. En este artículo se discuten los aspectos técnicos, inmunológicos y éticos relacionados con el transplante facial.

Facial disfigurement is a devastating condition. Facial transplantation has emerged as a new technique for severely disfigured patients. Eight facial transplants have been performed since 2005. Several aspects of facial transplantation are discussed including immunosuppressive, technical and ethical aspects.

[Histological evaluation of the effects of human bone matrix gelatin [BMG] with autogenous bone graft in the reconstruction of parietal bone defect in rats]

Autogenous bone grafts are commonly used for the reconstruction of bone defects in surgical procedures. The complication of preparing bone grafts and their application are important factors that have encouraged investigators to use human bone matrix gelatin human [BMG] which is one of the most popular graft materials. Because of the worldwide need for reconstruction of bone defects and its difficulty the aim of this study was to evaluate and compare the effects of BMG and auto graft on the reconstruction of bone defects in parietal bone of rats. In this experimental study, data was collected through microscopic observations. Human BMG produced using human Humorous bone based on Urist technical method. 12 healthy male Sprague dawley rats randomly assigned into 4 groups [3 rats in each group] and sacrificed in 7, 14, 24 and 60[th] days after surgery. Two defects were made in the left and right sides of parietal bone of all rats. Human BMG placed randomly in one side and auto graft in the other side and then all specimens in each group were assessed and compared histologically to each other. Assessments included amount, rate and type of bone formation, inflammation signs, fibrous tissue and cartilage formation to analyze the histologic findings, Wilcoxon-single rank test was used. The results showed a reduction of inflammation and also increase in new bone formation in both groups during 7, 14, 24 and 60th day after surgery. Bone formation percentage in human BMG cases in 24th day was more than autograft. There was no significant difference between two groups in 60th day. The findings suggested that although human BMG has the same effects as autograft, the rate of reconstruction with human BMG is more