FULL FACE TRANSPLANTATION: ORGANIZATION, DEVELOPMENT AND RESULTS

Juan Barret¹, Jordi Serracanta¹, Anna Arno¹, Vicens Garcia¹, Jose-Manuel Collado¹, Mireia Ruiz¹, Joan Gavalda², Javier Bueno³, Elena Arana¹, Anselmo Garrido¹, Jaume Sancho¹, Pablo Gomez¹

¹Department of Plastic Surgery and Burns; ²Department of Infectious Diseases; ³Department of Transplant Suregry and Pediatric Surgery, Hospital Universitari Vall d´Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.

Background: Since 2005, eleven human face transplants have been reported. In each, varying amounts of tissue have been transplanted. Herein we report a “full” face transplant including all intact aesthetic and functional units.

Methods: On March 27, 2010, we performed a full face transplant (type VB, according to Legele´s classification), including all the soft tissues and part of the underlying bony structure. The donor was a 41 year old male, who died from a massive brain hemorrhage. The recipient was a 30 year old male with a severe facial deformity caused by a ballistic trauma in 2005. Procurement and subsequent implant took 24 hours. A heart beating multiple organ donation was performed, with synchronous procurement of the facial allograft and the rest of the organs. The patient received initial induction (Thymoglobulin- 2mg/kg/iv; Prednisone- 1gm/iv) and maintenance (Prednisone- 1mg/kg/24h, Tacrolimus- 10-15ng/ml/PO and Mycophenolate mofetil- 2g/daily/PO) immunosuppression and Infection prophylaxis (Valganciclovir and Co-trimoxazole).

Results: There were no intraoperative complications. Postoperative complications included; venous anastomoses thrombosis, acute oro-cutaneous fistula, right parotid sialocele and 2 acute rejection episodes, which were resolved by revision of the anastomosis, profuse irrigation and immunotherapy adjustment, respectively. The patient was discharged from the hospital at 4 months post-transplant. Partial chimerism in peripheral blood appeared 6 months after surgery. The patient presented with a third acute rejection episode at 6 moths and CMV replication at 8 months without clinical implications. All rejection episodes resolved with iv administration of prednisone. Current outcome at 10 months shows total sensation and partial-motor recovery, no psychological complications and excellent acceptance of his new facial appearance.

Conclusions: The early success described in this case report demonstrates the technical and clinical feasibility of transplanting all the tissues of the face with all its aesthetic and functional units intact.