Current principles of facial allotransplantation: the Brigham and Women's Hospital Experience.

BACKGROUND: Facial allotransplantation is a revolutionary operation that has at last introduced the possibility of nearly normal facial restoration to patients afflicted by the most severe cases of facial disfigurement. METHODS: The facial transplantation team at Brigham and Women's Hospital evaluated more than 20 patients as potential face transplant recipients; of these, six became face transplant candidates and underwent full screening procedures. The team performed facial allotransplantations in four of these patients between April of 2009 and May of 2011. This is the largest clinical volume of facial transplant recipients in the United States to date. RESULTS: The authors have learned important lessons from each of these four unique cases and from the more than 20 patients that they have evaluated as potential face transplant recipients. The authors have translated lessons learned through direct experience into a set of fundamental surgical principles of the operation. CONCLUSIONS: The authors' surgical principles emphasize safety, technical feasibility, preservation of functional facial units, and return of motor and sensory function. This article describes each of these principles along with their rationale and, in some instances, illustrates their application.

Donor facial composite allograft recovery operation: Cleveland and Boston experiences.

BACKGROUND: Complexity of logistic issues related to facial transplantation includes donor tissue recovery, recipient preparation, and operative execution. Limited information is available on the intricate process associated with facial allograft procurement in the United States. METHODS: The face transplant teams at the Cleveland Clinic and Brigham and Women's Hospital have combined their experiences regarding collaboration with organ procurement organizations and institutional review boards, and outlined technical and logistic challenges encountered during the process of facial allograft procurement and compared them with those of solid organ procurement. RESULTS: In a collaborative effort, both programs have created comprehensive guidelines for all aspects involved in donor facial allograft procurement. CONCLUSIONS: The authors suggest that every face transplant team should develop a thorough understanding of the local and regional legislative issues related to organ and tissue donation and ethical concerns surrounding this procedure. The recovery plan has to be communicated extensively among all members of the team. The Cleveland and Boston teams hope their experiences may help other teams in the process of building new face transplant programs. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Face transplantation: a leading surgeon's perspective.

Twenty years of experience in the field of vascularized composite allografts (VCA) leading to the first US face transplantation is presented. Different experimental models and cadaveric studies in the VCA models are outlined. Development of face transplantation protocol and consent forms for Institutional Review Board approval is discussed. Different scientific, regulatory, and financial considerations that were required before approval of face transplantation are presented. The effort, importance, and role of multidisciplinary team approach are emphasized. Finally, the technical aspects of face transplantation and related immunologic and functional outcomes of the patients are discussed.

A multidisciplinary protocol for face transplantation at Brigham and Women's Hospital.

Face transplantation introduces an unprecedented potential to restore form and function in patients with severe facial disfigurement. A successful face transplantation programme requires a sound research protocol, a solid infrastructure, expert personnel and adequate funding. There are only a few active face transplant programmes in the world and interest in the development of new such programmes continues to grow. After 2 years of working on the development of the face transplant programme, in 2009 the team at Brigham and Women's Hospital (BWH) performed the 2nd face transplant in the United States. Since then, the team has continued to evaluate several possible face transplant candidates and performed three additional facial transplants. These experiences have helped refine a highly effective multidisciplinary protocol that carries a patient through recruitment, informed consent, screening, preoperative planning, face transplantation surgery and postoperative long-term follow-up. The members of the BWH face transplantation team responsible for carrying out this protocol include a team leader, a programme manager/coordinator, clinical and rehabilitation specialists, social workers, bioethicists, nurses and administrative staff. The roles of each team member during the various stages of the face transplant process are presented here. Additional insight into the interaction between the face transplant team, the Institutional Review Board and the regional Organ Procurement Organization is given. The BWH team's experience has shown that true collaboration, creativity and a unique approach to each candidate translate into the optimal care of the face transplant patient both before and after surgery.

Facial transplantation as an option in reconstructive surgery: no mountains too high?

BACKGROUND: Human facial allotransplantation (FA) is a testament to the impressive progress, which was and is still happening in the field of transplantation medicine and reconstructive surgery. Like every pioneering treatment option, FA faces both the clinicians' and public opinion with a huge amount of medical and psychosocial dilemmas, which, in order to introduce FA as a scientifically and socially accepted procedure into clinical practice, need to be discussed, answered and solved. METHODS: This review is based on a detailed literature research in all relevant databases (MEDLINE, PubMed, Cochrane Library, specialist textbooks), however, recent papers (published between 2006 and 2008) were given highest priority for inclusion. RESULTS: In this review, two main limitations associated with facial tissue allotransplantation, that is, shortage of donations and life-long need for immunosuppressive treatment, are discussed and presented in both psychosocial and medical terms. CONCLUSION: Although both of these limitations potentially could successfully inhibit the transformation of FA from an experimental therapy to the treatment of choice for patients with severe functional facial impairment, recent literature suggest that FA will find a meaningful place in facial reconstructive surgery.