Sosin Michael, Ceradini Daniel J, Levine Jamie P, Hazen Alexes, Staffenberg David A, Saadeh Pierre B, Flores Roberto L, Sweeney Nicole G, Bernstein G Leslie, Rodriguez Eduardo D
New York, N.Y.
From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Plast Reconstr Surg. 2016 Jul;138(1):205-219. doi: 10.1097/PRS.0000000000002322.
Reconstruction of extensive facial and scalp burns can be increasingly challenging, especially in patients that have undergone multiple procedures with less than ideal outcomes resulting in restricting neck and oral contractures, eyelid dysfunction, and suboptimal aesthetic appearance.
To establish a reconstructive solution for this challenging deformity, a multidisciplinary team was assembled to develop the foundation to a facial vascularized composite allotransplantation program. The strategy of developing and executing a clinical transplant was derived on the basis of fostering a cohesive and supportive institutional clinical environment, implementing computer software and advanced technology, establishing a cadaveric transplant model, performing a research facial procurement, and selecting an optimal candidate with the aforementioned burn defect who was well informed and had the desire to undergo face transplantation.
Approval from the institutional review board and organ procurement organization enabled our face transplant team to successfully perform a total face, eyelids, ears, scalp, and skeletal subunit transplant in a 41-year-old man with a full face and total scalp burn.
The culmination of knowledge attained from previous experiences continues to influence the progression of facial vascularized composite allotransplantation. This surgical endeavor methodically and effectively synchronized the fundamental principles of aesthetic, craniofacial, and microvascular surgery to restore appearance and function to a patient suffering from failed conventional surgery for full face and total scalp burns. This procedure represents the most extensive soft-tissue clinical face transplant performed to date.
CLINICAL QUESTION/LEVEL OF EVIDEMCE: Therapeutic, V.
广泛面部和头皮烧伤的重建手术难度日益增加，尤其是对于那些已经接受过多次手术但效果不理想，导致颈部和口腔挛缩、眼睑功能障碍以及美学外观欠佳的患者。
为了针对这一具有挑战性的畸形建立重建解决方案，组建了一个多学科团队，为面部血管化复合组织异体移植项目奠定基础。制定并实施临床移植的策略基于营造一个有凝聚力且支持性的机构临床环境、应用计算机软件和先进技术、建立尸体移植模型、开展面部研究性获取以及挑选一名患有上述烧伤缺陷且充分知情并愿意接受面部移植的最佳候选者。
获得机构审查委员会和器官获取组织的批准后，我们的面部移植团队成功为一名41岁全脸和全头皮烧伤男性实施了全脸、眼睑、耳朵、头皮和骨骼亚单位移植。
从以往经验中积累的知识不断影响着面部血管化复合组织异体移植的进展。这项手术有条不紊且有效地将美学、颅面和微血管手术的基本原则相结合，为一名因全脸和全头皮烧伤传统手术失败的患者恢复了外观和功能。该手术是迄今为止实施的最广泛的软组织临床面部移植。
临床问题/证据级别：治疗性，V级
