Shokri Tom, Saadi Robert, Wang Weitao, Reddy Likith, Ducic Yadranko
Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.
Department of Otolaryngology - Head & Neck Surgery, Penn State Health, Hershey, Pennsylvania.
Semin Plast Surg. 2020 Nov;34(4):245-253. doi: 10.1055/s-0040-1721760. Epub 2020 Dec 24.
Within the past two decades, vascularized facial composite allotransplantation has evolved into a viable option in the reconstructive surgeons' armamentarium for patients with extensive facial disfigurements. As it has expanded the frontiers of microsurgical reconstructive techniques, facial transplantation has come to garner widespread interest within both the medical community and the general public. The procedure has established itself as an amalgamation of the forefronts of reconstructive microsurgery, immunology, and transplantation science. Therein too lies its complexity as multifaceted scientific developments are met with ethical and social issues. Both patients and physicians are faced with the everlasting challenges of immunosuppression regimens and their inherent complications, long-term aesthetic and functional considerations, the role of revision procedures, and the inevitable psychosocial implications. This article reflects on the medical and surgical advancements in facial transplantation surgery and highlights anticipated future challenges. It aims to encourage discussion regarding anticipated barriers to current practice and suggest future directions as we transition into the next phase of facial allograft transplantation.
在过去二十年中,血管化面部复合组织移植已发展成为整形外科医生用于治疗大面积面部毁容患者的可行选择。随着它拓展了显微外科重建技术的前沿领域,面部移植已在医学界和普通公众中引起了广泛关注。该手术已成为重建显微外科、免疫学和移植科学前沿领域的融合。其中也存在其复杂性,因为多方面的科学发展面临着伦理和社会问题。患者和医生都面临着免疫抑制方案及其固有并发症、长期美学和功能考量、修复手术的作用以及不可避免的心理社会影响等长期挑战。本文回顾了面部移植手术的医学和外科进展,并强调了预期的未来挑战。其目的是鼓励就当前实践中预期的障碍进行讨论,并在我们过渡到面部同种异体移植的下一阶段时提出未来方向。