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INTRODUCTION

Face transplant (FT) has evolved enormously in the last
10 years since the successful completion of the first facial
transplant allograft (FAT) in November 2005 in Amiens
[1]
(France). However, scientific community must be cautious
because there are scarcely few selected cases in clinical
follow-up after a decade of clinical experience. In a literature
search in English from the PubMed/Medline data base
(http://www.ncbi.nlm.nih.gov/PubMed), with the following
search terms: “face”, “facial”, “transplant”, “transplantation”,
“composite allotransplant tissue” and “vascularized
composite allotransplant”, there have been reported clinical Figure 1: Countries in which a face transplant had been made in the last
data from 31 patients to date [Figures 1 and 2]. Although the decade
[2,3]
comparative analysis of data reported in these early clinical
cases shows that overall functional and aesthetic results in
FT are encouraging, there are still many unresolved aspects
of experimental research and clinical application to know
the real extent and the true dimension of this procedure.
This paper will review, point by point, major surgical,
immunological, ethical, and clinical follow-up aspects on FAT
published in the literature, from the analysis of the results
reported by pioneer FT teams on patients operated to date.

SURGICAL CONSIDERATIONS Figure 2: Evolution of the number of face transplant in the last decade

Preclinical models
The initial problem on the knowledge of FT is common
to other body transplants: to provide a basis for the study
of the surgical technique. That is why in recent years,
worldwide FT transplant teams have developed different
preclinical research in experimental surgery on animals and
cadaveric models. The pioneer teams have emphasized the
importance on this preclinical work prior for the completion
of a successful clinical transplantation. [4,5] FAT is a new
field in reconstructive surgery that is still considered as an Figure 3: Design of a facial transplant allograft in a Wistar rat. (a) Allograft
experimental and exceptional procedure. Therefore, it is pedicled in the external jugular vein and common carotid artery; (b)
external view of the allograft before anastomosis
imperative to establish a protocol and a previous training
to achieve excellence in this demanding procedure, to know aspects for anatomical structures of donors and recipients
perfectly the anatomy of the allograft needed in each case, are consistent in size and configuration to allow a reasonable
and to handle the tissues that compound the allograft. accommodation. Anthropometric study of facial soft and
hard tissues both the donor and the recipient must be as
The non-human primate model is the best suited since it accurate as possible to ensure the viability of the procedure
provides tissues of anatomical size and texture very similar and the proper insertion of the allograft into the defect, [27-29]
to humans. [6-9] Other models used have been rats, [10-14] rabbits even including the preparation of preoperative surgical
and dogs, [15,16] animals that are easy to use in a research osteotomy guides. [30-32]
center [Figure 3]. [17,18]
Overall aspects on surgery
Preclinical studies on cadavers have sought to find the best
way to recover soft and hard tissues, muscles, nerves and In FAT, microsurgical procedures are similar to those other
vessels of donor face while reducing tissue ischemia to complex reconstructive surgical procedures of the face. [33,34] The
the minimum. Studies on cadavers have been performed crux here is based on the exact surgical planning and surgical
with recovery simulations of lower, middle and/or upper execution considering to ensure the adequate perfusion
third face for FAT preparation [19-23] and development either and blood supply allograft, knowledge of angiosomes, and
partial or total. [4,5,24-26] Preclinical planning studies for vascularity of facial tissues. Allografts are recovered from the
implementation and validation of tools for planning, design donor in monobloc containing the facial osteomiocutaneous
and adaptation of allograft into recipients are other key tissues with mimic muscles, vessels and motor and sensory
212 Plast Aesthet Res || Volume 3 || June 24, 2016