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Face transplantation: Anesthetic challenges.

Aparna Dalal1

  • 1Aparna Dalal, Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.

World Journal of Transplantation
|January 7, 2017
PubMed
Summary
This summary is machine-generated.

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Face transplantation is a complex surgery involving multiple tissue types. Anesthesiologists face significant challenges managing bleeding and airway during this procedure.

Area of Science:

  • * Surgical and Transplant Science
  • * Anesthesiology and Critical Care Medicine

Background:

  • * Face transplantation is a complex vascular composite allotransplantation (VCA), involving the transfer of multiple tissue types including bone, muscles, blood vessels, and nerves.
  • * VCAs are now recognized under the Organ Procurement and Transplantation Network Final Rule and National Organ Transplant Act.
  • * The procedure requires meticulous planning and execution due to its complexity and potential for significant blood loss.

Approach:

  • * Review of anesthetic considerations and perioperative challenges in face transplantation.
  • * Discussion of surgical techniques, including tracheostomy, osteotomies, and the use of a silicone face mask for reconstruction.
  • * Emphasis on airway management strategies, such as primary intubation of a tracheostoma.

Key Points:

Keywords:
Face transplantationFacial reconstructionOrgan harvestVascular composite allotransplantation

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  • * Face transplantation is a lengthy procedure (19-20 hours) with a high risk of massive bleeding during dissection and reperfusion phases.
  • * Management of intraoperative hypotension may require pressors or infusions.
  • * Intraoperative product replacement should be guided by laboratory values and point-of-care testing for coagulation and hemostasis.

Conclusions:

  • * Anesthetic management for face transplantation requires careful attention to airway, massive hemorrhage control, and hemodynamic stability.
  • * Perioperative challenges include significant blood loss, the need for extensive blood product replacement, and complex airway management.
  • * This review highlights critical anesthetic considerations for successful face transplantation outcomes.