Facial Subunit Transplantation: Current Concepts and Future Directions

Area of Science:

• Reconstructive surgery
• Transplantation immunology

Background:

• Complex facial defects pose challenges for reconstructive surgery.
• Traditional methods often result in suboptimal outcomes.
• Facial vascularized composite allotransplantation (fVCA) is an option for extensive defects, but subunit transplantation is not yet clinical practice.

Purpose of the Study:

• To assess the feasibility, anatomical requirements, and immunosuppressive needs of facial subunit transplantation.
• To review preclinical and cadaver studies on vascularization and rejection.

Main Methods:

• Narrative review of animal models, human cadaver studies, and clinical experiences.
• Examination of preclinical studies on vascular supply and rejection.
• Analysis of cadaver studies on vascularization strategies for facial subunits.

Main Results:

• Facial subunit transplantation is anatomically feasible with established pedicle options.
• Immunosuppression protocols comparable to full-face transplantation are necessary.
• Preclinical models highlight the need for optimized immunosuppression for graft survival.

Conclusions:

• Facial subunit transplantation shows potential for improved outcomes in selective facial reconstruction.
• Advancements in immunosuppression and vascular planning are crucial for clinical application.
• Subunit transplantation could offer a less invasive alternative for localized facial defects.