Editors' ChoiceOrgan Transplantation

A face-lift for reconstructive surgery

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Science Translational Medicine  21 Aug 2019:
Vol. 11, Issue 506, eaaz0300
DOI: 10.1126/scitranslmed.aaz0300

Abstract

3D printing and digital modeling improve face transplantation for people affected by facial trauma unrepairable by traditional reconstructive surgery.

Since the first operation in 2005, face transplantation has been performed in 44 patients. This new frontier of reconstructive surgery brings new challenges to the surgeons, given the difficulty of making the transplanted face both functionally and aesthetically satisfying for the recipient. Fortunately, the success of the procedure has advanced considerably over the last ten years, in part due to increasingly interdisciplinary approaches.

Kantar et al. report a recent face transplantation case that used three-dimensional (3D) printing, computational modeling, and a new immunosuppression strategy. The transplant recipient was disfigured at the central and lower face by a ballistic trauma; his eyes and forehead remained intact. The nasofrontal, zygomatic (cheekbone), and mandibular (jaw bone) regions of the transplant recipient were replaced with those of the donor. Face dissection was planned by using 3D digital models of the donor and recipient skulls, which were reconstructed from computed tomographic scans. Cutting guides for dissection were customized using the digital models and fabricated by 3D printing for use during the transplant operation, to match the geometry of the donor and the recipient faces. A mask of optimal donor likeness was 3D printed and used to cover the donor’s facial defect.

To enable the recipient to feel and control the donor face, the recipient’s facial nerves were connected to that of the donor face. Nerves for different facial parts, such as zygomatic, buccal, and marginal mandibular nerves, were identified using intraoperative nerve stimulation technique. To guarantee good blood perfusion, before operation the arteries and veins of the donor and recipient were located precisely using angiography and digital 3D reconstruction. This allowed the authors to efficiently locate facial veins and suture the donor’s veins to the recipient’s external jugular veins, re-establishing blood circulation during surgery. A new immunosuppression regimen depleting T and B lymphocytes was also used.

The operation showed a satisfactory outcome, and the recipient remained rejection-free one year after surgery. Incorporation of new technologies and standardized perioperative processes have greatly contributed to this successful case. Regenerative medicine may one day become capable of growing new faces for patients. Until that time, advances in face transplantation as reported here will continue to provide a hope-filled solution for patients suffering from devastating facial trauma.

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