Aycart Mario A, Alhefzi Muayyad, Kueckelhaus Maximilian, Krezdorn Nicco, Bueno Ericka M, Caterson Edward J, Pribaz Julian J, Pomahac Bohdan
Boston, Mass.; and Bochum, Germany.
From the Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School; and the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum.
Plast Reconstr Surg. 2016 Oct;138(4):690e-701e. doi: 10.1097/PRS.0000000000002605.
Face transplantation has emerged as a viable option for certain patients in the treatment of devastating facial injuries. However, as with autologous free tissue transfer, the need for secondary revisions in face transplantation also exists. The authors' group has quantified the number of revision operations in their cohort and has assessed the rationale, safety, and outcomes of posttransplantation revisions.
A retrospective analysis of prospectively collected data of the authors' seven face transplants was performed from April of 2009 to July of 2015. The patients' medical records, preoperative facial defects, and all operative reports (index and secondary revisions) were critically reviewed.
The average number of revision procedures was 2.6 per patient (range, zero to five procedures). The median time interval from face transplantation to revision surgery was 5 months (range, 1 to 10 months). Most interventions consisted of debulking of the allograft, superficial musculoaponeurotic system plication and suspension, and local tissue rearrangement. There were no major infections, allograft skin flap loss, or necrosis. One patient suffered a postoperative complication after autologous fat grafting in the form of acute rejection that resolved with pulse steroids.
Secondary revisions after face transplantation are necessary components of care, as they are after most conventional free tissue transfers. Secondary revisions after face transplantation at the authors' institution have addressed both aesthetic and functional reconstructive needs, and these procedures have proven to be safe in the context of maintenance immunosuppression. Patient and procedure selection along with timing are essential to ensure patient safety, optimal function, and aesthetic outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
面部移植已成为某些严重面部损伤患者可行的治疗选择。然而，与自体游离组织移植一样，面部移植也需要进行二次修复。作者团队已对其队列中的修复手术数量进行了量化，并评估了移植后修复的基本原理、安全性和结果。
对作者在2009年4月至2015年7月期间进行的7例面部移植的前瞻性收集数据进行回顾性分析。对患者的病历、术前面部缺损以及所有手术报告（初次和二次修复）进行了严格审查。
每位患者的平均修复手术次数为2.6次（范围为0至5次）。从面部移植到修复手术的中位时间间隔为5个月（范围为1至10个月）。大多数干预措施包括减少同种异体移植物的体积、浅表肌肉腱膜系统折叠和悬吊以及局部组织重新排列。没有发生重大感染、同种异体皮肤瓣丢失或坏死。一名患者在自体脂肪移植后出现急性排斥反应的术后并发症，经脉冲类固醇治疗后缓解。
面部移植后的二次修复是护理的必要组成部分，就像大多数传统游离组织移植后一样。作者所在机构的面部移植后二次修复满足了美学和功能重建需求，并且这些手术在维持免疫抑制的情况下已被证明是安全的。患者和手术的选择以及时机对于确保患者安全、最佳功能和美学效果至关重要。
临床问题/证据水平：治疗性，V级
