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dilemma since it is linked to the difficulty of obtaining 6. Silverman RP, Banks ND, Detolla LJ, Shipley ST, Panda A, Sanchez RA,
informed children consent, psychological instability during Azimzadeh AM, Pierson RN 3rd, Wang D, Rodriguez ED, Holton LH 3rd,
the years of growth, risk of cancer and complications of Bartlett ST. A heterotopic primate model for facial composite tissue
transplantation. Ann Plast Surg 2008;60:209-16.
immunosuppression throughout a long life ahead. Another 7. Barth RN, Bluebond-Langner R, Nam A, Stanwix M, Shipley S, Bartlett ST,
aspect to consider is the high economic costs of FT, [54,99] Rodriguez ED. Facial subunit composite tissue allografts in nonhuman
both the procedure and the immunosuppressive lifetime primates I. Technical and functional requirements for prolonged graft
therapy, preventing its widespread application and opens 8. survival. Plast Reconst Surg 2009;123:493-501.
Kuo YR, Shih HS, Lin CC, Huang CC, Yang JC, Wu WS, Goto S, Chen CL,
the discussion of opportunity-cost for countries with public Lee WP. Swine hemi-facial composite tissue allotrasplantation: a model to
health services. [54,99] study immune rejection. J Surg Res 2009;153:268-73.
9. Baek RM, Eun SC, Heo CY, Chang H. Experimental facial transplantation
surgery. J Craniofac Surg 2010;21:648-51.
FUTURE DIRECTIONS 10. Ulusal BG, Ulusal AE, Ozmen S, Zins JE, Siemionow MZ. A new composite
facial and scalp transplantation model in rats. Plast Reconst Surg
From the first FT performed a decade ago, more than 2003;112:1302-11.
thirty FAT have been performed worldwide with promising 11. Landin L, Cavadas PC. The mystacial pad flap: a functional facial flap in rats.
Ann Plast Surg 2005;56:107-8.
immunological, functional, psychological and aesthetic 12. Yazici I, Carnevale K, Klimczak A, Siemionow M. A new rat model of
results that have clearly demonstrated the feasibility of maxilla allotransplantation. Ann Plast Surg 2007;58:338-44.
this demanding process. Unlike solid organ transplant that 13. Landin L, Cavadas PC, Gonzalez E, Rodriguez JC, Caballero A. Funcional
“potentially saved a life”, what FAT provides is a “change outcome after facial allograft transplantation in rats. J Plast Reconst Aesth
Surg 2008;61:1034-43.
of life” to recipients. This substantial difference has created 14. Kulahci Y, Siemionow M. A new composite hemiface/mandible/tongue
ethical concerns in society about the exposure of individuals transplantation model in rats. Ann Plast Surg 2010;64:114-21.
(young and otherwise healthy) to potential immunological 15. Liu Q, Li Q, Zheng S, Zheng D. Preservation of canine composite facial flaps
complications and the ability to provide informed consent. using UW solution. Arch Facial Plast Surg 2010;12:263-8.
On the other hand, the incessant advance in microsurgical 16. Yu D, Li Q, Zheng S, Wang H, Liu Q. Some results of our research on
composite tissue transplantation in dogs. Transplant Proc 2010;42:1953-5.
techniques and the computer assisted surgical planning, 17. Yazici I, Unal S, Siemionow M. Composite hemiface/calvaria transplantation
have progressively allowed a broader clinical application model in rats. Plast Reconst Surg 2011;118:1321-7.
of this procedure, and have promoted the evolution from 18. Ramirez AE, Lao WW, Wang YL, Cheng HY, Wei FC. Two-stage
the first partial FT to full procedures of FT. All these are on face transplantation: a new concept in vascularized composite
allotransplantation. Microsurgery 2015;35:218-26.
the basis of accurate and careful selection of well-motivated 19. Siemionow M, Agaoglu G, Unal S. A cadaver study in preparation for facial
candidates. There is a firm belief in the scientific community allograft transplantation in humans: part II. Mock facial transplantation.
that, at present, surgical innovations in the field of FT have Plast Reconstr Surg 2006;117:876-85.
overcome to some extent immune, medical and ethical 20. Lengelé BG. Current concepts and future challenges in facial transplantation.
Clin Plast Surg 2009;36:507-21.
aspects. However, FT is still an experimental procedure in 21. Meningaud JP, Benjoar MD, Hivelin M, Hermeziu O, Toure G, Lantieri L.
which we have much to learn. Next challenge will be getting Procurement of total human face graft for allotransplantation: a preclinical
new strategies for more effective immunosuppressive study and the first clinical case. Plast Reconstr Surg 2010;126:1181-90.
therapy and improved donor-specific tolerance. There are 22. Gordon CR, Susarla SM, Peacock ZS, Cetrulo CL, Zins JE, Papay F, Kaban LB,
still unresolved problems and crucial aspects to define the Yaremchuk MJ. Osteocutaneous maxillofacial allotransplantation: lessons
learned from a novel cadaver study applying orthognathic principles and
true role of the FAT in the current reconstructive surgery. practice. Plast Reconstr Surg 2011;128:465-79.
23. Meningaud JP, Hivelin M, Benjoar MD, Toure G, Hermeziu O, Lantieri L. The
Financial support and sponsorship procurement of allotransplants for ballistic trauma: a preclinical study and
Nil. a report of two clinical cases. Plast Reconstr Surg 2011;127:1892-900.
24. Gastman B, Djohan R, Siemionow M. Extending the Cordeiro maxillofacial
defect classification system for use in the era of vascularized composite
Conflicts of interest transplantation. Plast Reconstr Surg 2012;130:419-22.
There are no conflicts of interest. 25. Baccarani A, Follmar KE, Erdmann D, Levin LS. Face transplantation
surgical options and open problems in cadaveric models: a review article.
Microsurgery 2013;33:239-46.
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