Zeiderman Matthew R, Firriolo Joseph M, Dave Dattesh R, Pu Lee L Q
Division of Plastic Surgery, Department of Surgery, University of California at Davis, Sacramento, Calif.
Plast Reconstr Surg Glob Open. 2020 Jul 14;8(7):e2962. doi: 10.1097/GOX.0000000000002962. eCollection 2020 Jul.
With advancements in microsurgical technique and experience, face transplantation is becoming a clinical reality and acceptable procedure. Preparation of the maxillofacial skeleton and initial soft-tissue coverage for face transplant candidates is essential for optimizing the ultimate outcome by providing immediate coverage of vital structures, functionality, and a stable skeletal framework. We present our experience of preparing such a patient who underwent a successful face transplant, with an excellent outcome. A 24-year-old man sustained a self-inflicted ballistic injury to his face. Composite tissue deficits included significant soft-tissue loss in the central lower and midface, comminuted fractures of midface, and large bone gaps of the maxilla and mandible. He underwent open reduction internal fixation of bilateral LeFort III, zygomaticomaxillary complex, and complex maxillary and mandibular fractures with titanium plates and a free anterolateral thigh perforator flap to the midface with concomitant pedicled left supraclavicular artery fasciocutaneous flap to the lower face. He subsequently underwent a second free anterolateral thigh perforator for the exposed mandibular hardware due to partial necrosis of the supraclavicular artery fasciocutaneous flap. The patient achieved stable bone reconstruction and soft-tissue coverage and was discharged home. He was placed on the waiting list for a face transplant by another center in the country and eventually underwent a successful face transplant. We believe that the preparation of the patient with complex craniomaxillofacial trauma for face transplant should be considered when the extent of injury exceeds conventional reconstructive limits. Our approach provides the best opportunity for an optimal face transplant outcome while minimizing flap donor site morbidity.
随着显微外科技术的进步和经验的积累，面部移植正成为一种临床现实且可接受的手术。为面部移植候选者准备颌面骨骼并进行初始软组织覆盖，对于通过立即覆盖重要结构、实现功能以及提供稳定的骨骼框架来优化最终结果至关重要。我们介绍了为一名成功接受面部移植且效果极佳的患者进行准备工作的经验。一名24岁男性面部遭受自伤性弹道损伤。复合组织缺损包括面中下部严重软组织缺失、面中部粉碎性骨折以及上颌骨和下颌骨的大骨缺损。他接受了双侧LeFort III型、颧骨上颌复合体以及复杂的上颌骨和下颌骨骨折的切开复位内固定术，使用钛板固定，并采用游离股前外侧穿支皮瓣修复面中部，同时使用带蒂左锁骨上动脉筋膜皮瓣修复面下部。由于锁骨上动脉筋膜皮瓣部分坏死，他随后又接受了一次游离股前外侧穿支皮瓣修复暴露的下颌骨固定装置。患者实现了稳定的骨重建和软组织覆盖，随后出院。他被该国另一个中心列入面部移植等待名单，最终成功接受了面部移植。我们认为，当损伤程度超过传统重建限度时，应为面部移植准备患有复杂颅颌面创伤的患者。我们的方法为实现最佳面部移植效果提供了最佳机会，同时将皮瓣供区的发病率降至最低。
