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Surgical Approach to Full Soft Tissue Face Allograft Procurement for Vascularized Composite Allotransplantation

Surgical Approach to Full Soft Tissue Face Allograft Procurement for Vascularized Composite Allotransplantation

Published on: December 30, 2025

Algorithm for total face and multiorgan procurement from a brain-dead donor.

P S Brazio¹, R N Barth, B Bojovic

¹Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons

|August 7, 2013

Summary

This summary is machine-generated.

This study presents a "face first, concurrent completion" algorithm for facial vascularized composite allograft (VCA) procurement. This approach ensures solid organ integrity during complex facial transplantation, optimizing outcomes.

Keywords:

Composite tissue transplantation face transplantation multiorgan donor organ and tissue procurement organ protection and preservation organ sharing

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Area of Science:

Transplantation Surgery
Vascularized Composite Allotransplantation (VCA)
Organ Procurement

Background:

Facial vascularized composite allograft (VCA) procurement is time-intensive, potentially leading to prolonged ischemia.
Simultaneous procurement of solid organs alongside a facial VCA presents logistical challenges.
Ensuring the integrity of both facial grafts and solid organs is critical for successful transplantation.

Observation:

A novel "face first, concurrent completion" procurement algorithm was developed and applied.
Facial dissection was performed over 15 hours, with 12 hours dedicated to minimizing ischemia.
Solid organ recovery occurred concurrently with facial osteotomies and dissection, starting at 13.5 hours.

Findings:

The described technique allowed for the procurement of a total face osteomyocutaneous VCA and all solid organs.
Concurrent procurement minimized ischemic times for both the facial VCA and solid organs.
All procured organs demonstrated good postoperative function, indicating successful preservation.

Implications:

This algorithm provides a viable strategy for complex facial VCA procurement, balancing graft and organ recovery.
Concurrent surgical team operations can optimize resource utilization and reduce overall procurement time.
Early initiation of recipient surgery may mitigate challenges associated with extensive recipient scarring.