Ramly Elie P, Kantar Rami S, Diaz-Siso J Rodrigo, Alfonso Allyson R, Rodriguez Eduardo D
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y.
Plast Reconstr Surg Glob Open. 2019 Aug 19;7(8):e2379. doi: 10.1097/GOX.0000000000002379. eCollection 2019 Aug.
Face transplant (FT) candidates present with unique anatomic and functional defects unsuitable for autologous reconstruction, making the accurate design and transplantation of patient-specific allografts particularly challenging. In this case series, we present our computerized surgical planning (CSP) protocol for FT.
CSP, computer-aided design and manufacturing, intraoperative navigation, and intraoperative computerized tomography have been successfully incorporated into a comprehensive protocol. Three consecutive FTs were performed. CSP and postoperative results were compared using computerized tomography-derived cephalometric measurements, and the literature was reviewed.
Two full and 1 partial FT were successfully performed using the CSP protocol. CSP facilitated the execution of FT with minor angular and translational cephalometric variations on immediate postoperative imaging. Our evolving experience was accompanied by a decreased reliance on cadaveric simulation, from 10 mock transplants and a research procurement before the senior author's first clinical FT (2012) to 6 mock transplants and no research procurement before the third FT (2018). Operative time was significantly reduced from 36 to 25 hours, as was the need for major orthognathic surgical revision. This reflects the learning curve and variable case complexity, but it is also representative of improved planning and execution, complemented by the systematic incorporation of CSP into FT.
A CSP protocol allows for refinement of operative flow, technique, and outcomes in partial and full FT. Standards for functional and esthetic outcomes are bound to evolve with the field's growth, and computerized planning and execution offer a reproducible approach to FT through objective quality assurance.
面部移植（FT）候选者存在独特的解剖和功能缺陷，不适用于自体重建，这使得精确设计和移植患者特异性同种异体移植物极具挑战性。在本病例系列中，我们展示了我们用于面部移植的计算机化手术规划（CSP）方案。
CSP、计算机辅助设计与制造、术中导航以及术中计算机断层扫描已成功整合到一个综合方案中。连续进行了3例面部移植手术。使用计算机断层扫描衍生的头影测量法比较CSP和术后结果，并对文献进行了综述。
使用CSP方案成功进行了2例全脸和1例部分面部移植。CSP有助于面部移植的实施，术后即刻成像时头影测量的角度和移位变化较小。随着经验的不断积累，我们对尸体模拟的依赖减少了，从资深作者首次临床面部移植（2012年）前的10次模拟移植和一次研究性取材，到第三次面部移植（2018年）前的6次模拟移植且无研究性取材。手术时间从36小时显著减少至25小时，重大正颌外科修复的需求也减少了。这反映了学习曲线和病例复杂性的差异，但也代表了规划和实施的改进，以及将CSP系统地纳入面部移植。
CSP方案可优化部分和全脸面部移植的手术流程、技术及结果。随着该领域的发展，功能和美学结果的标准必然会不断演变，而计算机化规划和实施通过客观的质量保证为面部移植提供了一种可重复的方法。
