Preoperative clinical management of patients who are candidates for facial transplantation / Manejo clínico pré-operatório de pacientes candidatos ao transplante facial

Introduction: Face transplantation has gained recognition, changing the clinicalsurgical scenario for restoring complex facial defects, as it attributes functional and aesthetic recovery to patients who have suffered serious accidents. At the time of writing this article, in official publications, 43 patients had already undergone facial transplantation worldwide. Face transplantation has numerous pieces of evidence that can irrefutably provide improvements to the patient. For this, preoperative care for the patient must be carefully established so that there is good surgical performance. Case Report: Male patient, 46 years old, reports that, at the age of 6, he had burns due to exposure to gasoline, with 72% of his body surface burned, showing sequelae of burns and surgical reconstructions on the face, with redundant and ptotic skin flap on the left cheek, absence of upper and lower lip and exposure of lower teeth. Conclusion: It is important to publicize this innovative procedure in different medical specialties and preoperative care through a thorough investigation, which attributes better surgical effectiveness, allowing the rescue of their facial identity, once stigmatized.

Introdução: O transplante de face adquiriu reconhecimento, alterando o panorama clínico-cirúrgico para a restauração de defeitos faciais complexos, visto que atribui recuperação funcional e estética a pacientes que sofreram acidentes graves. Até o momento da redação deste artigo, em publicações oficiais, 43 pacientes já haviam realizado o transplante facial em todo mundo. O transplante de face possui inúmeras evidências que podem fornecer melhorias ao paciente de forma irrefutável. Para isso, cuidados pré-operatórios ao paciente devem ser cuidadosamente estabelecidos para que haja um bom desempenho cirúrgico. Relato de Caso: Paciente sexo masculino, 46 anos, relata que, aos 6 anos de idade, teve queimadura por exposição à gasolina, com 72% de superfície corporal queimada, apresentando sequelas de queimaduras e reconstruções cirúrgicas na face, com retalho cutâneo redundante e ptótico em bochecha esquerda, ausência de lábio superior e inferior e exposição dos dentes inferiores. Conclusão: Ressalta-se a importância da divulgação desse procedimento inovador em diferentes especialidades médicas e dos cuidados pré-operatórios através de uma investigação minuciosa, que atribuem uma melhor eficácia cirúrgica, possibilitando o resgate de sua identidade facial, uma vez estigmatizada.

Facial lipo-filling using high-density fat combined with SVF-GEL / 中华整形外科杂志

Objective@#To discuss the effect of high-density fat-binding SVF-GEL in female facial lipofilling.@*Methods@#This is a retrospective study including 32 female patients, received facial fat transplantation during June 2017 to June 2018 in Yichun College. Each patient underwent high-density fat-binding SVF-GEL transplantation for facial surgery. Patients′satisfaction with the surgery and the rate of secondary surgery was evaluated. Fat was harvested from the inner thigh, centrifuged at 1200 g for 3 min, and the liquid was removed. The upper 2/3 part is prepared for SVF-GEL, for further used in delicate lipofilling in eyelid, tear groove and nasolabial groove. The lower 1/3 high density fat was used for volume restoration, such as forehead, temporal area and cheek.@*Results@#All patients had significant improvements in facial contours with mild swelling and short recovery time. The satisfaction rate was 68.8%(22/32), and the second operation rate was 15.6%(5/32).@*Conclusions@#High-density fat-binding SVF-GEL transplantation can achieve good results in correcting facial volume loss.

Facial Transplantation Surgery Introduction

Severely disfiguring facial injuries can have a devastating impact on the patient's quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie "Face/Off" have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea.

Face transplantation in rats. Reproducibility of the experimental model in Brazil

PURPOSE: To investigate the reproducibility of the experimental model of face allotransplantation in rats in Brazil. METHODS: Eighteen rats were operated, nine-nine donors recipients. Animals underwent transplantation of the left hemiface, with periorbital and scalp. Transplants were made from donor Wistar rats to recipients Lewis rats. Flaps were based on the common carotid artery and the external jugular vein of the donor animal and the anastomosis in the recipient area was performed in common carotid artery (end-to-side) and in external jugular vein (end-to-end). RESULTS: Of the nine recipient animals operated, six survived and three progressed to death in the first days after surgery (survival rate = 67%). The mean time of the procedure was 252 minutes and the mean time of flap ischemia was 95 minutes. The five surviving animals were sacrificed at 14 days, in good general condition and without signs of tissue rejection. CONCLUSIONS: The experimental model of face allotransplantation in rats is reproducible in our midst. Duration of surgery, time of flap ischemia, animal survival rate and complications observed were similar to those described in the literature. .

Hemifacial Transplantation Model in Rats

BACKGROUND: To refine facial transplantation techniques and achieve sound results, it is essential to develop a suitable animal model. Rat is a small animal and has many advantages over other animals that have been used as transplantation models. The purpose of this study was to describe a rat hemifacial transplantation model and to verify its convenience and reproducibility. METHODS: Animals used in this study were Lewis rats (recipients) and Lewis-Brown Norway rats (donors). Nine transplantations were performed, requiring 18 animals. The hemifacial flap that included the ipsilateral ear was harvested based on the unilateral common carotid artery and external jugular vein and was transferred as a single unit. Cyclosporine A therapy was initiated 24 hours after transplantation and lasted for 2 weeks. Signs of rejection responses were evaluated daily. RESULTS: The mean transplantation time was 1 hour 20 minutes. The anatomy of common carotid artery and external jugular vein was consistent, and the vessel size was appropriate for anastomosis. Six of nine allografts remained good viable without vascular problems at the conclusion of study (postoperative 2 weeks). CONCLUSION: The rat hemifacial transplantation model is suitable as a standard transplantation training model.

Hemifacial Transplantation Model in Rats

BACKGROUND: To refine facial transplantation techniques and achieve sound results, it is essential to develop a suitable animal model. Rat is a small animal and has many advantages over other animals that have been used as transplantation models. The purpose of this study was to describe a rat hemifacial transplantation model and to verify its convenience and reproducibility. METHODS: Animals used in this study were Lewis rats (recipients) and Lewis-Brown Norway rats (donors). Nine transplantations were performed, requiring 18 animals. The hemifacial flap that included the ipsilateral ear was harvested based on the unilateral common carotid artery and external jugular vein and was transferred as a single unit. Cyclosporine A therapy was initiated 24 hours after transplantation and lasted for 2 weeks. Signs of rejection responses were evaluated daily. RESULTS: The mean transplantation time was 1 hour 20 minutes. The anatomy of common carotid artery and external jugular vein was consistent, and the vessel size was appropriate for anastomosis. Six of nine allografts remained good viable without vascular problems at the conclusion of study (postoperative 2 weeks). CONCLUSION: The rat hemifacial transplantation model is suitable as a standard transplantation training model.

Transplante facial: una realidad clínica / Facial transplantation: a reality

La desfiguración de la cara es una condición devastadora. El transplante facial ha surgido como una nueva alternativa de tratamiento para pacientes con desfiguración severa. Ocho transplantes faciales se han llevado a cabo desde el año 2005. En este artículo se discuten los aspectos técnicos, inmunológicos y éticos relacionados con el transplante facial.

Facial disfigurement is a devastating condition. Facial transplantation has emerged as a new technique for severely disfigured patients. Eight facial transplants have been performed since 2005. Several aspects of facial transplantation are discussed including immunosuppressive, technical and ethical aspects.

Implicaciones médico legales del trasplante facial / Medicolegal implications in the facial transplantation

Un hecho reciente que ha causado revuelo en la comunidad médica internacional ha sido la noticia de la realización del primer trasplante parcial de cara en Francia. Con este hecho se ha vuelto a poner sobre el tapete un tema que desde el punto de vista médico, psicosocial y ético ha generado polémica. Asimismo, puede tener implicaciones desde el enfoque medicolegal. Los trasplantes han tenido un desarrollo vertiginoso desde los inicios del siglo XX, desarrollando técnicas microquirúrgicas y fármacos inmunomoduladores capaces de garantizar un alto porcentaje de éxito. Sin embargo en este momento el trasplante facial estaría indicado para un reducido número de casos con severas lesiones faciales en los cuales las técnicas convencionales no ofreciesen más ayuda. Además los pacientes tendrían que dar su consentimiento informado a un procedimiento que aún está en fase experimental y del cual no se conocen con certeza las consecuencias a corto, mediano y largo plazo. Desde el punto de vista medicolegal implicaría principalmente la modificación de la evolución usual de los estados secuelares funcionales y estéticos del rostro.

A recent fact that has caused commotion in the international medical community has been the news of first partial face transplantation executed in France. With this fact, this theme has been put again on the covering. Since the medical, psychosocial and ethical point of view, it has generated polemics. Likewise, it can have medicolegal implications. The transplants have had a giddy development since the starts of the 20th century, when were developed microsurgical techniques and then inmunosuppressant drugs. With both there was a high percentage of transplant success. Nevertheless, at this time, the facial transplant would be indicated for a reduced number of patients with severe facial wounds, in which the conventional techniques don't offer more helps. Also, it is necessary that the patients give their informed consent for a surgery that is still in experimental phase and of which we don't know with certainty the consequences to short, medium and long time limit. From the forensic point of view it would mainly imply the modification of the usual evolution of the functional and aesthetic injury consequences.