Facial Transplantation

Abstract

The evolution of facial reconstruction has seen significant advances over the last century. The advent of microsurgical techniques created the ability to transfer autogenous tissue from donor sites across the body, allowing complex defects to become amenable to reconstruction. Despite all of these advances, the fundamental limitation of free tissue transfer is the inability to repair complex neuromuscular defects, especially those in the mid-face. While the concept of allograft transplantation and its use has been widely accepted in the arena of solid organ transplantation, the concept of skin transplantation is relatively new with the first successful hand transplant that occurred in 1998. Facial transplants followed in 2005 (Devauchelle et al. Lancet 368:203–209, 2006). This technique offers a potential solution for these neuromuscular mid-face injuries that cannot be reconstructed with traditional approaches. This article discusses the limits of conventional reconstruction, the rationale for facial transplantation, and the clinical outcomes of two cases of near total facial transplants. Both patients have had excellent short- and long-term outcomes. The future of this technique and its role in facial reconstruction appears promising.