Roche Nathalie A, Blondeel Phillip N, Vermeersch Hubert F, Peeters Patrick C, Lemmens Gilbert M D, De Cubber Jan, De Letter Miet, Van Lierde Kristiane
*Department of Plastic and Reconstructive Surgery †Department of Head and Neck and Maxillo-Facial Surgery ‡Department of Nephrology §Department of Psychiatry, Ghent University Hospital, Ghent ||Center for Craniofacial Epithetics, Zaventem ¶Department of Speech, Language and Hearing Sciences, Ghent University Hospital, Ghent, Belgium.
J Craniofac Surg. 2015 Oct;26(7):2038-46. doi: 10.1097/SCS.0000000000002110.
Vascularized composite allotransplantation (VCA) to reconstruct complex centrally located facial defects and to restore vital functions in a 1-staged procedure has worldwide gained acceptance. Continuous long-term multidisciplinary follow-up of face transplant patients is mandatory for surveillance of the complications associated with the immunosuppressive regime and for functional assessment of the graft. In December 2011, our multidisciplinary team performed a digitally planned face transplant at the Ghent University Hospital, Belgium on a 55-year-old man with a large central facial defect after a high-energy ballistic injury. The patient was closely followed to assess functional recovery, immunosuppressive complications, overall well-being, and quality of life. Three years postoperatively, the patient and his family are very satisfied with the overall outcome, and social reintegration in the community is successful. Motor and sensory functions have recovered near normal. Infectious and medical complications have been serious but successfully managed. Immunosuppressive maintenance therapy consists of corticoids, tacrolimus, and mycophenolate mofetil in minimal doses. Epithetic reconstruction of both eyes gave a tremendous improvement on the overall aesthetic outcome. Despite serious complications during the first 12 months, multifunctional outcome in the first face transplant in Belgium (#19 worldwide) is successful. This should be attributed to the continuous and long-term multidisciplinary team approach. As only few reports of other face transplant patients on long-term follow-up are available, more data need to be collected and reported to further outweigh the risk benefit ratio of this life changing surgery.
采用血管化复合组织异体移植（VCA）在一期手术中重建位于面部中央的复杂缺损并恢复重要功能，已在全球范围内得到认可。对面部移植患者进行持续的长期多学科随访对于监测与免疫抑制方案相关的并发症以及评估移植物的功能至关重要。2011年12月，我们的多学科团队在比利时根特大学医院为一名55岁男性进行了数字化规划的面部移植手术，该患者因高能弹道损伤导致面部中央出现大面积缺损。对该患者进行了密切随访，以评估功能恢复情况、免疫抑制并发症、整体健康状况和生活质量。术后三年，患者及其家人对总体结果非常满意，并且在社区中成功实现了社会重新融入。运动和感觉功能已恢复至接近正常水平。感染性和医疗并发症虽较为严重，但已成功处理。免疫抑制维持治疗采用最低剂量的皮质类固醇、他克莫司和霉酚酸酯。双眼的整形重建极大地改善了整体美学效果。尽管在最初的12个月中出现了严重并发症，但比利时首例面部移植（全球第19例）的多功能结果是成功的。这应归功于持续的长期多学科团队方法。由于仅有少数关于其他面部移植患者长期随访的报告，因此需要收集和报告更多数据，以进一步权衡这种改变生活的手术的风险效益比。
