This page contains exclusive content for the member of the following sections: TTS, IHCTAS. Log in to view.
Presenter: Juan, Barret, Barcelona, Spain
Authors: Juan Barret, Jordi Serracanta, Anna Arno, Vicens Garcia, Jose-Manuel Collado, Mireia Ruiz, Joan Gavalda, Javier Bueno, Elena Arana, Anselmo Garrido, Jaume Sancho, Pablo Gomez
Juan Barret1, Jordi Serracanta1, Anna Arno1, Vicens Garcia1, Jose-Manuel Collado1, Mireia Ruiz1, Joan Gavalda2, Javier Bueno3, Elena Arana1, Anselmo Garrido1, Jaume Sancho1, Pablo Gomez1
1Department of Plastic Surgery and Burns; 2Department of Infectious Diseases; 3Department of Transplant Suregry and Pediatric Surgery, Hospital Universitari Vall d´Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Background: Since 2005, eleven human face transplants have been reported. In each, varying amounts of tissue have been transplanted. Herein we report a “full” face transplant including all intact aesthetic and functional units.
Methods: On March 27, 2010, we performed a full face transplant (type VB, according to Legele´s classification), including all the soft tissues and part of the underlying bony structure. The donor was a 41 year old male, who died from a massive brain hemorrhage. The recipient was a 30 year old male with a severe facial deformity caused by a ballistic trauma in 2005. Procurement and subsequent implant took 24 hours. A heart beating multiple organ donation was performed, with synchronous procurement of the facial allograft and the rest of the organs. The patient received initial induction (Thymoglobulin- 2mg/kg/iv; Prednisone- 1gm/iv) and maintenance (Prednisone- 1mg/kg/24h, Tacrolimus- 10-15ng/ml/PO and Mycophenolate mofetil- 2g/daily/PO) immunosuppression and Infection prophylaxis (Valganciclovir and Co-trimoxazole).
Results: There were no intraoperative complications. Postoperative complications included; venous anastomoses thrombosis, acute oro-cutaneous fistula, right parotid sialocele and 2 acute rejection episodes, which were resolved by revision of the anastomosis, profuse irrigation and immunotherapy adjustment, respectively. The patient was discharged from the hospital at 4 months post-transplant. Partial chimerism in peripheral blood appeared 6 months after surgery. The patient presented with a third acute rejection episode at 6 moths and CMV replication at 8 months without clinical implications. All rejection episodes resolved with iv administration of prednisone. Current outcome at 10 months shows total sensation and partial-motor recovery, no psychological complications and excellent acceptance of his new facial appearance.
Conclusions: The early success described in this case report demonstrates the technical and clinical feasibility of transplanting all the tissues of the face with all its aesthetic and functional units intact.
By viewing the material on this site you understand and accept that:
The Transplantation Society
740 Notre-Dame Ouest
Montréal, QC, H3C 3X6