Créteil, France From the Université Paris 12, Faculté de Médecine, IFR10, and AP-HP, Groupe Henri Mondor-Albert Chenevier, Service de Chirurgie Plastique, Reconstructrice, et Esthétique.
Plast Reconstr Surg. 2010 Oct;126(4):1181-1190. doi: 10.1097/PRS.0b013e3181ec2089.
The authors report the technical difficulties involved in the procurement of a total human face graft for allotransplantation.
After completing a preclinical study that involved 13 fresh cadavers, the authors harvested a total face graft for allotransplantation onto a patient in April of 2009. The harvested tissue specimen included the entire face along with the scalp and the auricles. The authors then removed the unnecessary parts, specifically, the lips and the skin overlying the chin.
The preclinical study and clinical results confirmed that complete revascularization of a total face graft, complete with the scalp and auricles, from a single external carotid vascular pedicle was possible. All dissections were completed in less than 6 hours during the preclinical study. Graft procurement for the clinical case took 11 hours. Facial soft tissues were harvested en bloc to decrease graft harvest time and prevent tissue injury. A resin mask that covered the entire face of the donor provided excellent cosmetic results. All nerves and eyelid structures were easily reattached. One month after transplantation, skin necrosis necessitated several stages of excision. Biopsy specimens from the transplanted tissue were negative for immune-mediated rejection. Unfortunately, the patient experienced a cardiac arrest during follow-up surgery and died 2 months after the transplant procedure.
A composite tissue allotransplantation of the total face along with the scalp and the auricles is technically feasible. The authors' flap provided reliable vascularization and was obtained in a standardized fashion in less than 11 hours. The graft contained all of the perioral muscles, branches of the facial nerve, eyelid structures, and major salivary glands.
作者报告了获取同种异体全脸面移植所需的技术困难。
在完成了涉及 13 例新鲜尸体的临床前研究后，作者于 2009 年 4 月为一名患者采集了全脸面移植用的同种异体移植物。采集的组织标本包括整个面部、头皮和耳廓。然后，作者去除了不必要的部分，特别是嘴唇和下巴上的皮肤。
临床前研究和临床结果证实，从单个颈外血管蒂上的全脸面移植，包括头皮和耳廓，可以实现完全再血管化。在临床前研究中，所有的解剖都在不到 6 小时内完成。临床病例的移植物采集耗时 11 小时。整块采集面颈部软组织以减少移植物采集时间并防止组织损伤。供体的树脂面罩覆盖了整个面部，获得了良好的美容效果。所有神经和眼睑结构都很容易重新连接。移植后 1 个月，皮肤坏死需要进行多次切除。移植组织的活检标本均未发生免疫介导的排斥反应。不幸的是，患者在随访手术中发生心脏骤停，移植后 2 个月死亡。
全脸面、头皮和耳廓的复合组织同种异体移植在技术上是可行的。作者的皮瓣提供了可靠的血供，并且可以在不到 11 小时的时间内以标准化的方式获得。移植物包含了所有的口周肌肉、面神经分支、眼睑结构和主要唾液腺。
