Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
Am J Transplant. 2013 Oct;13(10):2743-9. doi: 10.1111/ajt.12382. Epub 2013 Aug 5.
Procurement of a facial vascularized composite allograft (VCA) should allow concurrent procurement of all solid organs and ensure their integrity. Because full facial procurement is time-intensive, "simultaneous-start" procurement could entail VCA ischemia over 12 h. We procured a total face osteomyocutaneous VCA from a brain-dead donor. Bedside tracheostomy and facial mask impression were performed preoperative day 1. Solid organ recovery included heart, lungs, liver, kidneys, and pancreas. Facial dissection time was 12 h over 15 h to diminish ischemia while awaiting recipient preparation. Solid organ recovery began at 13.5 h, during midfacial osteotomies, and concluded immediately after facial explantation. Facial thoracic and abdominal teams worked concurrently. Estimated blood loss was 1300 mL, requiring five units of pRBC and two units FFP. Urine output, MAP, pH and PaO2 remained normal. All organs had good postoperative function. We propose an algorithm that allows "face first, concurrent completion" recovery of a complex facial VCA by planning multiple pathways to expedient recovery of vital organs in the event of clinical instability. Beginning the recipient operation earlier may reduce waiting time due to extensive recipient scarring causing difficult dissection.
获取面部血管化复合移植物（VCA）时，应允许同时获取所有实体器官，并确保其完整性。由于全面部采集时间较长，“同时开始”采集可能导致 VCA 缺血超过 12 小时。我们从脑死亡供体中获取了一个全脸面骨肌肉皮瓣 VCA。术前第一天进行床边气管切开术和面部面罩印模。实体器官回收包括心脏、肺、肝、肾和胰腺。为了减少缺血，面部解剖时间为 15 小时 12 小时，同时等待受者准备。实体器官回收在 13.5 小时开始，在中面部截骨术期间进行，并在面部取出后立即完成。面部胸腹部团队同时进行工作。估计失血量为 1300 毫升，需要 5 个单位的 PRBC 和 2 个单位的 FFP。尿量、MAP、pH 值和 PaO2 均正常。所有器官术后功能良好。我们提出了一种算法，允许通过规划多条途径，以快速恢复重要器官，从而实现复杂面部 VCA 的“先面后，同时完成”回收。如果临床不稳定，更早开始接受者手术可能会减少因广泛的接受者疤痕导致难以解剖而导致的等待时间。
