From the Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome.
Division of Plastic and Reconstructive Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy.
Ann Plast Surg. 2021 Apr 1;86(4):469-475. doi: 10.1097/SAP.0000000000002632.
The aim of this study was to report the first case of acute facial allograft transplantation (facial allograft transplantation) failure with allograft removal and autologous free-flap reconstruction.
A 49-year-old female patient affected by neurofibromatosis type 1 with a massive neurofibroma infiltrating the whole left hemiface was planned for FAT for the left hemiface including the auricle, all skin and soft tissues from the temporal region, periorbital and nasal region, and up to the perioral area. The maxillary process of the zygomatic bone, left hemimaxilla, and hemimandible from contralateral parasyphysis to the incisura mandibulae were also included.
Total surgical time was 26 hours. There were 2 intraoperative arterial thromboses that were solved with new anastomoses and sufficient flap perfusion. On postoperative day 2, the allograft became pale with suspected arterial occlusion and the patient returned to the operative room for exploration no flow into the FAT was found. The allograft was removed and the recipient site reconstructed with a skin-grafted composite left latissimus dorsi-serratus anterior flap.
Hyperacute loss of FAT is a very dramatic event, and the activation of a backup surgical plan is crucial to save patient's life, give a reasonable temporary reconstruction, and return on the waiting-list for a second face transplantation.
本研究旨在报告首例急性面部同种异体移植（面部同种异体移植）失败伴同种异体移植物切除和自体游离皮瓣重建的病例。
一名 49 岁女性患者患有 1 型神经纤维瘤病，左侧面部有一个巨大的神经纤维瘤，累及整个左侧半脸，包括耳廓、颞区、眶周和鼻区的所有皮肤和软组织，以及口周区域。还包括颧骨的上颌突、左侧上颌骨和从对侧副颏下至下颌切迹的半下颌骨。
总手术时间为 26 小时。术中发生 2 次动脉血栓形成，通过新吻合和足够的皮瓣灌注解决。术后第 2 天，供体移植物变苍白，怀疑动脉闭塞，患者返回手术室探查，发现无 FAT 血流。切除移植物，用皮瓣移植的复合左侧背阔肌-前锯肌皮瓣重建受区。
FAT 超急性丧失是一个非常戏剧性的事件，激活备用手术方案对于挽救患者生命、提供合理的临时重建以及返回第二次面部移植的等候名单至关重要。
