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Surgical Approach to Full Soft Tissue Face Allograft Procurement for Vascularized Composite Allotransplantation
Published on: December 30, 2025
Novel surgical technique for full face transplantation
Bohdan Pomahac1, Julian J Pribaz, Ericka M Bueno
1Boston, Mass. From the Division of Plastic Surgery, Brigham and Women's Hospital and Harvard Medical School, and the Harvard Combined Plastic Surgery Residency Program, Harvard Medical School.
Plastic and Reconstructive Surgery
|May 12, 2012
Summary
This study introduces a novel technique for full face transplantation using only facial arteries for blood supply. This method simplifies allograft recovery, improves nerve coaptation, and enhances aesthetic outcomes.
Area of Science:
- Surgical Innovation
- Transplantation Medicine
- Plastic Surgery
Background:
- Full face transplantation presents unique ethical and technical challenges compared to partial procedures.
- Traditional methods required parotid gland inclusion, leading to suboptimal aesthetics and nerve coaptation.
- Existing techniques limited facial nerve repair to the main trunk, often causing synkinesias.
Purpose of the Study:
- To present a novel approach for full facial allograft recovery utilizing facial arteries exclusively.
- To eliminate the need for parotid gland inclusion in full face transplants.
- To enable more precise facial nerve coaptation for improved functional and aesthetic results.
Main Methods:
- Developed a technique for full facial allograft recovery focusing on facial artery blood supply.
- Performed three mock cadaver dissections and three full face transplantations.
- Dissected donor allografts cranio-caudally and laterally-to-medially, preserving facial nerve branches.
Main Results:
- Achieved successful perfusion of full facial allografts using only bilateral facial arteries.
- Generally excluded parotid glands, with one used for added bulk.
- Facial nerve branches were coapted to corresponding recipient nerves distal to the parotid glands.
- Allografts demonstrated immediate perfusion and survival post-transplantation.
Conclusions:
- A new, simple, and reproducible technique for full facial allograft recovery has been described.
- The technique ensures allograft perfusion via bilateral facial arteries alone.
- This method adheres to critical principles for targeted sensory and motor nerve coaptation.
