• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.5
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• pp.342-351
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• 2013

Advances in immunosuppressive treatments and microsurgical techniques have rendered composite tissues allotransplantation (CTA), such as heteregeneous or non-organ tissues, possible in humans. CTA has evolved dramatically since the first successful rat hind limb allotransplantation. Numerous clinical applications including face, hand, trachea, larynx, and vascularized joint have been performed. Although composite tissue allografts are still in their infancy, they have opened a new era in the field of transplantation surgery and pathology, so that maxillofacial reconstructive surgeons may occasionally be faced with the challenge of diagnosing skin refection of a composite tissue allograft. Facial allotransplantation (FAT) is a new surgical technique that could be considered as a new paradigm in facial reconstruction. Since the first human FAT had been achieved in 2005, 17 cases have been reported in the world up to date. However, many problems such as life-long immunosuppression, immune rejection, ethical problems and psychological problems are remained, so facial CTA is new reconstructive option with no general acceptance. The authors reviewed the indications, the results of 17 cases and their complications, and additional consideration factors in this article, and intended to raise the awareness of oral and maxillofacial surgeons in this type of facial transplantation.

• Archives of Craniofacial Surgery
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• v.12 no.2
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• pp.86-92
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• 2011

Purpose: The purpose of this study was to investigate the possibility that a dynamic facial composite flap with sensory and motor nerves could be made available from donor facial composite tissue. Methods: The faces of 3 human cadavers were dissected. The authors studied the donor faces to assess which facial composite model would be most practicable. A "panorama facial flap" was excised from each facial skeleton with circumferential incision of the oral mucosa, lower conjunctiva and endonasal mucosa. In addition, the authors measured the available length of the arterial and venous pedicles, and the sensory nerves. In the recipient, the authors evaluated the time required to anastomose the vessels and nerve coaptations, anchor stitches for donor flaps, and skin stitches for closure. Results: In the panorama facial flap, the available anastomosing vessels were the facial artery and vein. The sensory nerves that required anastomoses were the infraorbital nerve and inferior alveolar nerve. The motor nerve requiring anstomoses was the facial nerve. The vascular pedicle of the panorama facial flap is the facial artery and vein. The longest length was 78 mm and 48 mm respectively. Sensation of the donor facial composite is supplied by the infraorbital nerve and inferior alveolar nerve. Motion of the facial composite is supplied by the facial nerve. Some branches of the facial nerve can be anastomosed, if necessary. Conclusion: The most practical facial composite flap would be a mid and lower face flap, and we proposed a panorama facial flap that is designed to incorporate the mid and lower facial skin with and the unique tissue of the lip. The panorama facial composite flap could be considered as one of the practicable basic models for facial allotransplantation.

• Korean Journal of Cleft Lip And Palate
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• v.14 no.1_2
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• pp.45-56
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• 2011

Face transplantation has been reported over the last six years, and it started in 2004 with the announcement of Cleveland Clinic granting the world's first IRB approval to proceed with human face transplantation. Composite tissue allografts (CTAs) in the facial region are considered to be more immunogenic than other solid organ transplants, so these kinds of animal experiments were also considered as challengeable activities to the facial reconstructive surgeons. For the better understanding of CTAs in the oral and maxillofacial fields, we reviewed several recent articles about facial composite transplantation animal model, and summarized some knowledges of composite midface allotransplantation model with sensory and motor reinnervation in this review article.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.555-560
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• 2010

Purpose: Facial allotransplantation (FA) could provide an excellent alternative to current treatments for facial disfigurement. However, despite being technically feasible, there continues to be various ethical and psychosocial issues associated with the risks and benefits of performing FA. The purpose of this study is to investigate risk acceptance and expectations in FA. Methods: In a quantitative assessment of risk versus benefit with respect to FA, from 2004 to 2008, Barker et al. developed and published a questionnaire-based instrument (Louisville Instrument for Transplantation [LIFT]), which contained 237 standardized questions. In the current study, the authors assessed risk versus benefits and expectations of FA using a Korean version of the LIFT. Respondents in three study groups (lay public, n=140; medical students, n=120; doctors, n=34) were questioned about risk acceptance as related to immunosuppression and tissue rejection, and expectations as related to quality of life improvement, and functional and aesthetic outcomes. A summary of the data has been provided and statistical analyses were performed. Results: Among the three study groups, results indicated that doctors accept the least amount of risk for a facial allotransplant, followed by medical students, and finally lay public. There was a significant statistical difference in three of the four questions regarding risk acceptance between the groups (p < 0.05). In general, lay public exhibited higher expectations for facial allotransplantation than the other groups. Additionally, there was a significant statistical difference in the importance of aesthetic outcome between the groups (p < 0.05). Conclusion: The authors' data indicate the three populations have vastly different levels of risk acceptance and expectations with regard to FA. Therefore, it is very important that surgeons establish clear, open, and thorough communication with patients in their consultations regarding FA. This is particularly important with respect to whether or not a patient's level of risk acceptance and expectations are progmatic.

• Archives of Reconstructive Microsurgery
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• v.14 no.2
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• pp.95-104
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• 2005

The aim of this study was to investigate the major vascular system to supply flap, flap survival rate and complications after flap elevation in order to evaluate possibility of the vascularized face/scalp allotransplantation. Forty New Zealand white rabbits were divided into two groups: control group and experimental group. Individuals of control group had a face/scalp composite unit which was composed of skin, subcutaneous tissue and platysma muscle, supplying by bilateral facial artery, temporal artery and auricular artery and draining by external jugular vein. After a flap was elevated, bilateral facial artery, temporal artery and auricular artery were ligated. On the other hand, those of experimental group had the same composite unit as control group with bilateral facial artery, temporal artery and auricular artery being not ligated. We had measured survival area of flaps of the sixteen individuals survived for four weeks in the control group and fourteen in the experimental group by Grid method. The mean survival durations of the flap were 3.7days in the control group, 20.0days in the experimental group. The significant differences in the mean survival durations and survival rate at the 28days were found between the control and experimental group (p<0.05). Mean values about the survival area's fractions of all were $1.3{\pm}4.%$ in the control group and $63.1{\pm}4.8%$ in the experimental group. Those of experimental group was significantly higher than control group statistically (p<0.05). The composite face/scalp flap which we have elevated, supplied by bilateral facial artery, temporal artery, auricular artery and drained by external jugular vein has flap viability enough to be transplanted after its elevation.

• Archives of Craniofacial Surgery
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• v.15 no.2
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• pp.89-93
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• 2014

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.