Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation

The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles

Michael Sosin, Daniel J. Ceradini, Alexes Hazen, Jamie P. Levine, David A. Staffenberg, Pierre B. Saadeh, Roberto L. Flores, Lawrence E. Brecht, G. Leslie Bernstein, Eduardo D. Rodriguez

Research output: Contribution to journalArticle

Abstract

Background: The application of aesthetic, craniofacial, and microsurgical principles in the execution of face transplantation may improve outcomes. Optimal soft-tissue face transplantation can be achieved by incorporating subunit facial skeletal replacement and subsequent tissue resuspension. The purpose of this study was to establish a reconstructive solution for a full face and scalp burn and to evaluate outcome precision and consistency. Methods: Seven mock face transplants (14 cadavers) were completed in the span of 1 year. Components of the vascularized composite allograft included the eyelids, nose, lips, facial muscles, oral mucosa, total scalp, and ears; and skeletal subunits of the zygoma, nasal bone, and genial segment. Virtual surgical planning was used for osteotomy selection, and to evaluate postoperative precision of hard-and soft-tissue elements. Results: Each transplant experience decreased each subsequent transplant surgical time. Prefabricated cutting guides facilitated a faster dissection of both donor and recipient tissue, requiring minimal alteration to the allograft for proper fixation of bony segments during inset. Regardless of donor-to-recipient size discrepancy, ample soft tissue was available to achieve tension-free allograft inset. Differences between virtual transplant simulation and posttransplant measurements were minimal or insignificant, supporting replicable and precise outcomes. Conclusions: This facial transplant model was designed to optimize reconstruction of extensive soft-tissue defects of the craniofacial region representative of electrical, thermal, and chemical burns, by incorporating skeletal subunits within the allograft. The implementation of aesthetic, craniofacial, and microsurgical principles and computer-assisted technology improves surgical precision, decreases operative time, and may optimize function.

Original languageEnglish (US)
Pages (from-to)1569-1581
Number of pages13
JournalPlastic and Reconstructive Surgery
Volume137
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

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Facial Transplantation
Microsurgery
Eyelids
Scalp
Esthetics
Cadaver
Ear
Allografts
Transplants
Operative Time
Composite Tissue Allografts
Nasal Bone
Chemical Burns
Facial Muscles
Zygoma
Tissue Transplantation
Mouth Mucosa
Osteotomy
Lip
Nose

ASJC Scopus subject areas

  • Surgery

Cite this

Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation : The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles. / Sosin, Michael; Ceradini, Daniel J.; Hazen, Alexes; Levine, Jamie P.; Staffenberg, David A.; Saadeh, Pierre B.; Flores, Roberto L.; Brecht, Lawrence E.; Bernstein, G. Leslie; Rodriguez, Eduardo D.

In: Plastic and Reconstructive Surgery, Vol. 137, No. 5, 01.05.2016, p. 1569-1581.

Research output: Contribution to journalArticle

Sosin, M, Ceradini, DJ, Hazen, A, Levine, JP, Staffenberg, DA, Saadeh, PB, Flores, RL, Brecht, LE, Bernstein, GL & Rodriguez, ED 2016, 'Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation: The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles', Plastic and Reconstructive Surgery, vol. 137, no. 5, pp. 1569-1581. https://doi.org/10.1097/PRS.0000000000002122
Sosin, Michael ; Ceradini, Daniel J. ; Hazen, Alexes ; Levine, Jamie P. ; Staffenberg, David A. ; Saadeh, Pierre B. ; Flores, Roberto L. ; Brecht, Lawrence E. ; Bernstein, G. Leslie ; Rodriguez, Eduardo D. / Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation : The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles. In: Plastic and Reconstructive Surgery. 2016 ; Vol. 137, No. 5. pp. 1569-1581.
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abstract = "Background: The application of aesthetic, craniofacial, and microsurgical principles in the execution of face transplantation may improve outcomes. Optimal soft-tissue face transplantation can be achieved by incorporating subunit facial skeletal replacement and subsequent tissue resuspension. The purpose of this study was to establish a reconstructive solution for a full face and scalp burn and to evaluate outcome precision and consistency. Methods: Seven mock face transplants (14 cadavers) were completed in the span of 1 year. Components of the vascularized composite allograft included the eyelids, nose, lips, facial muscles, oral mucosa, total scalp, and ears; and skeletal subunits of the zygoma, nasal bone, and genial segment. Virtual surgical planning was used for osteotomy selection, and to evaluate postoperative precision of hard-and soft-tissue elements. Results: Each transplant experience decreased each subsequent transplant surgical time. Prefabricated cutting guides facilitated a faster dissection of both donor and recipient tissue, requiring minimal alteration to the allograft for proper fixation of bony segments during inset. Regardless of donor-to-recipient size discrepancy, ample soft tissue was available to achieve tension-free allograft inset. Differences between virtual transplant simulation and posttransplant measurements were minimal or insignificant, supporting replicable and precise outcomes. Conclusions: This facial transplant model was designed to optimize reconstruction of extensive soft-tissue defects of the craniofacial region representative of electrical, thermal, and chemical burns, by incorporating skeletal subunits within the allograft. The implementation of aesthetic, craniofacial, and microsurgical principles and computer-assisted technology improves surgical precision, decreases operative time, and may optimize function.",
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AU - Ceradini, Daniel J.

AU - Hazen, Alexes

AU - Levine, Jamie P.

AU - Staffenberg, David A.

AU - Saadeh, Pierre B.

AU - Flores, Roberto L.

AU - Brecht, Lawrence E.

AU - Bernstein, G. Leslie

AU - Rodriguez, Eduardo D.

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