Transplant professionals' attitudes toward facial transplantation in the United Kingdom.

BACKGROUND: In November 2005, the world's first partial facial transplantation positioned this treatment at the forefront in the development of facial reconstructive techniques. OBJECTIVE: Because the procedure is dependent on donation of facial tissue, we sought to understand the attitudes and beliefs of the general public and transplant professionals toward this treatment. METHODS: This research reports the results of a survey of 170 transplant professionals sampled by means of a questionnaire generated by a focus group of transplant coordinators. RESULTS: We found a high level of support for facial transplantation, with 76% of respondents in favor and none opposed to the procedure in principle. There was a significant association between knowing someone with a disfiguring condition and being in favor of facial transplantation. Areas of concern to this group can be summarized as factors that affect organ retrieval and the impact on the retrieval team and the donor family. CONCLUSIONS: Consistency in ranking of item importance provides the basis for development of relevant education materials, team liaison, and care pathways. These findings also validate the use of focus groups in sampling issues of concern to relevant groups as facial transplantation takes its place as a reconstructive option.

An artificial prosthesis to reconstruct donor defects following facial transplantation.

Post-harvest donor facial appearance is likely to have an impact on both the donor family and the transplant harvest team. We describe a method of fabricating a donor-specific artificial prosthesis, which can be constructed within the time frame of the facial graft harvest.

The use of color Doppler ultrasound in the assessment of vessels for facial transplantation.

The facial artery has been proposed as the main vascular pedicle in facial transplantation. An anatomic study of 200 consecutive facial and transverse facial vessels in 100 normal individuals was performed using color Doppler ultrasound. The diameter and course of each facial vessel were measured at 3 fixed landmarks, and the branching pattern was documented up to the level of the nasal ala. The concomitant transverse artery and vein were similarly documented. The main branch of the facial artery was detected at the lower mandibular border in 99.5% (n = 199) of cases. The accompanying facial vein was found in 97.5% (n = 195) of cases, lateral to the artery in all cases. The transverse facial artery was present in 75.5% (n = 151) of cases, with the vein found in 58% (n = 116). When the facial artery was undetectable, there was transverse facial artery dominance. When the facial vein was absent, it was replaced with a transverse facial vein; this venous anomaly was accompanied by normal arterial supply pattern. This study is the first to describe the measurement of transverse facial vessels sonographically and confirms previous cadaveric studies of facial arterial and venous variation. Color Doppler can be used in the preoperative vascular assessment of both donor and recipient in facial transplantation.

Informed consent for facial transplantation.

Now that partial face transplantation has been performed, attention is focused on likely functional, aesthetic and immunological outcomes, and full facial transplantation is the likely next step. Facial transplantation has been the source of ethical debate, a key part of which focuses on valid informed consent. We review the process of informed consent in health settings, assessing how applicable the current standards are for facial transplantation. The factors which need to be assessed during the screening programme are outlined. We conclude that both individual and process factors are important in obtaining consent for radical new procedures, and outline our own gold standard for ensuring informed consent in facial transplantation.

An algorithm for the release of burn contractures of the extremities.

Burn contractures of the extremities present a clinical challenge. Flexion contractures are more common than extension contractures. The first component of treatment is adequate contracture release. A number of different methods are available for resurfacing the wound and these are reviewed. An algorithm is presented which permits a simple approach to managing burn scar contracture of the extremities.