Vascular considerations in composite midfacial allotransplantation

Area of Science:

• Reconstructive surgery
• Transplantation immunology
• Vascular anatomy

Background:

• Microsurgery and immunosuppression have advanced facial composite tissue allografts.
• Maxilla and palate vascularity, supplied by facial arteries, presents a challenge in midface transplantation.
• Donor tissue recovery is unique for each patient, with midface transplantation becoming a frequent indication.

Purpose of the Study:

• To discuss vascular considerations for the transplantation of the entire midface.
• To evaluate the feasibility of central facial allotransplantation.
• To elucidate technical points for safe and functional face transplant surgery.

Main Methods:

• Preclinical cadaver dissections of four individuals were performed to identify key anatomical structures.
• An extended midfacial allotransplantation was conducted in April 2009.
• The allograft included facial mimetic muscles, skin, nerves, nose, upper lip, maxilla, teeth, and hard palate.

Main Results:

• Dissections revealed an anastomotic network connecting facial and angular vessels to maxillary vessels via the periosteum and bony canals.
• Transplantation of a central face allograft, including the maxilla and palate, was deemed feasible.
• A technically successful clinical case of extended midfacial allotransplantation was completed.

Conclusions:

• Anatomical and clinical findings highlight critical technical aspects of midface composite tissue transplantation.
• Careful graft harvest, precise donor/recipient vessel selection, and complete revascularization are essential.
• Restoration of sensory and motor function is crucial for successful and functional face transplant outcomes.