Principles of face transplant revision: Beyond primary repair

Raja Mohan, Mark Fisher, Amir Dorafshar, Michael Sosin, Branko Bojovic, Dheeraj Gandhi, Nicholas Iliff, Eduardo D. Rodriguez

Research output: Contribution to journalArticle

Abstract

Background: Over the past decade, facial vascularized composite allotransplantation has earned its place at the top of the reconstructive ladder. However, as in free tissue transfer, postoperative revisions are necessary to achieve optimal functional and aesthetic results. Although revising a facial vascularized composite allotransplantation may potentially risk the integrity of the graft, the authors believe that the advantages of appropriately chosen revisions may provide great benefit. Methods: Following the most extensive face transplant performed to date, revisions were performed in two surgical procedures. The first included a Le Fort III osteotomy for malocclusion correction, midface tissue resuspension and coronal eyebrow lift to correct soft-tissue ptosis, and submental lipectomy. Bilateral blepharoplasty to minimize tissue excess and scar revision were performed at a subsequent operation. Cephalometric analysis and angiography were performed and blink data collected. Results: Before transplantation, the patient was in class III malocclusion. After transplantation, class I occlusion was obtained; however, the patient subsequently returned to class III occlusion. After skeletal revision, class I occlusion was obtained; however, a corneal blink deficit was noted. Eight months after skeletal revision, blink had improved spontaneously. Angiography revealed collateralization providing retrograde flow from the flap to the recipient. Conclusions: Although the necessity for revisions is clear, determining which revisions to safely perform and their timing and execution have not been explored. The authors address four distinct categories of revisions, including soft-tissue revision, hard-tissue mismatch, and craniofacial skeleton and dental occlusion. The authors illustrate the success of these revisions and assess their advantages, disadvantages, and relative risk.

Original languageEnglish (US)
Pages (from-to)1295-1304
Number of pages10
JournalPlastic and reconstructive surgery
Volume134
Issue number6
DOIs
StatePublished - Jan 1 2014

ASJC Scopus subject areas

  • Surgery

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    Mohan, R., Fisher, M., Dorafshar, A., Sosin, M., Bojovic, B., Gandhi, D., Iliff, N., & Rodriguez, E. D. (2014). Principles of face transplant revision: Beyond primary repair. Plastic and reconstructive surgery, 134(6), 1295-1304. https://doi.org/10.1097/PRS.0000000000000760