From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine.
the Yale-New Haven Transplantation Center.
Plast Reconstr Surg. 2024 Sep 1;154(3):577e-584e. doi: 10.1097/PRS.0000000000011058. Epub 2023 Sep 12.
Face transplantation has emerged as a viable solution for reconstructing the most complex facial injuries. Previous work has demonstrated that surgical revisions are necessary to optimize outcomes. The authors' group has updated the previous report of revisions in their cohort, quantified and described which revisions were performed for functional, aesthetic, or mixed indications, and described the rationale, safety, and long-term outcomes of these revisions.
A retrospective analysis of the authors' 10 face transplants from April of 2009 to February of 2023 was performed. The patients' medical records, preoperative facial defects, and operative reports (index and secondary revisions) were reviewed.
Nine patients were included. One patient underwent irreversible acute-on-chronic allograft rejection and received a second face transplant. The average number of revisions was 5.2 per patient (range, 2 to 11 procedures). The median time interval from transplantation to first revision was 4 months (range, 1 to 21 months). Median follow-up was 106 months (range, 39 to 142 months). Most interventions consisted of debulking the allograft or revising the periorbital tissues.
In the current study, the authors report longer-term data on revision procedures needed in face transplant recipients. Patients should expect to undergo revisions for both functional and aesthetic considerations. Although the majority of revisions are performed within 2 years after transplantation, revisions can be safely performed at any time point. Shared decision-making between the patient and provider team is essential in deciding which revisions are performed and when.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
面部移植已成为重建最复杂面部损伤的可行方法。先前的工作表明，需要进行手术修正以优化结果。作者小组更新了他们队列中修正的先前报告，量化并描述了为功能、美学或混合适应症进行的修正，并描述了这些修正的原理、安全性和长期结果。
对作者 2009 年 4 月至 2023 年 2 月的 10 例面部移植患者进行回顾性分析。回顾了患者的病历、术前面部缺陷和手术报告（索引和二次修正）。
纳入 9 例患者。1 例患者发生不可逆的慢性移植物急性排斥反应，接受了第二次面部移植。每位患者的平均修正次数为 5.2 次（范围为 2 至 11 次手术）。从移植到第一次修正的中位时间间隔为 4 个月（范围为 1 至 21 个月）。中位随访时间为 106 个月（范围为 39 至 142 个月）。大多数干预措施包括切除移植物或修正眶周组织。
在当前研究中，作者报告了面部移植受者需要进行修正手术的长期数据。患者应预计需要进行功能和美学方面的修正。尽管大多数修正手术在移植后 2 年内进行，但在任何时间点都可以安全地进行修正。患者和提供者团队之间的共同决策对于决定进行哪些修正以及何时进行修正至关重要。
临床问题/证据水平：治疗，V。
