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

Full facial vascularized composite allotransplantation (VCA) offers a reconstructive option for patients with severe facial disfigurement who cannot be treated with conventional methods. This article details a surgical protocol for donor procurement of a full facial allograft, focusing on soft tissue with limited bony harvest restricted to the nasal framework, and emphasizes key anatomical landmarks and technical considerations for safe and efficient harvest. The procedure involves dissection of the entire facial soft tissues while preserving the external carotid artery, internal jugular veins and subsequent thyro-linguofacial, and branches of the facial and maxillary nerves to maximize pedicle length for later neurorrhaphy. The protocol describes systematic exposure of the vascular pedicles at their origin in the neck, subperiosteal elevation of the scalp, identification and division of the supraorbital and infraorbital nerves, and preparation of the facial nerve at its root to achieve optimal length. Strategies to minimize ischemia time and ensure allograft integrity are highlighted. This article provides a comprehensive visual guide to the procurement phase of a full soft tissue face allograft and aims to standardize the technique for research application and surgical training in advanced vascularized composite allotransplantation.