Current role in facial allograft transplantation:what have we learned?

Face transplant(FT)has evolved enormously in the last 10 years since the successful completion of the first facial transplant.This procedure has become a new reconstructive option for complex facial deformities to restore the anatomy of patients with severely disfigured faces.The authors review the literature and discuss the main surgical,immunological,and ethical aspects as well as the results described in patients undergoing FT.To date there have been more than thirty FT worldwide.The main indication was post-traumatic deformity.In all cases a standard immunosuppression was performed with three drugs,although acute rejection episodes were observed,that could be controlled with conventional immunosuppressive regimen.Overall,functional and aesthetic results have been excellent at short-term and high satisfaction rate exceeded initial expectations,although long-term data are still scarce.Major complications were opportunistic infections.Five deaths that occurred have reopened the ethical debate about the potential complications and concerns of providing informed consent to recipients.Continuous progresses in microsurgical techniques and preoperative planning have promoted the evolution from partial to full FT.All these are on the basis of accurate and careful selection of well-motivated candidates.The next challenge will be getting new immunosuppressive treatment strategies.Although clinical experience has demonstrated the FT viability,it is still considered an experimental procedure in which we have much to learn to define its true role in the current reconstructive surgery and resolve major technical,medical and ethical problems involved.

Anatomical features associated with venous congestion in DIEP flap using CT angiography with three-dimensional reconstruction

Aim: Computed tomography angiography (CTA) using three-dimensional (3D) virtual reconstruction has been increasingly used in planning deep inferior epigastric artery perforator (DIEP) breast reconstruction. Although the most common complication associated with this surgery is diffuse venous congestion, its origin remains unclear. The aim of this study was to assess the anatomical characteristics of the anterior abdominal wall vessels that could predict venous congestion, using CTA with 3D virtual reconstruction. Methods: A retrospective case-control study was conducted and a total of 169 DIEP flaps were reviewed. An abdominal CTA with 3D virtual reconstruction was analyzed with regard to anatomical features of the abdominal wall vessels. Seven venous congestive cases were identified. For each case, 3 controls that had not exhibited any vascular complications were randomly selected. Results: The global venous congestion rate was 4.14%. No statistically significant differences were found between the groups' superficial inferior epigastric vein (SIEV) diameter (P = 0.915), number of branches of SIEV (P = 0.371), number of perforators per flap (P = 0.255), flap subcutaneous tissue thickness (P = 0.652), direct communications between SIEV-perforators (P = 0.418), and communications of both SIEVs across the abdominal midline (P = 0.371). Conclusion: The present study provided new information concerning the identification of the controversial anatomical features associated with venous congestion in DIEP flaps. CTA and 3D virtual reconstruction were useful tools for evaluating the abdominal wall anatomy and for planning DIEP breast surgery, but neither for predicting nor preventing the diffuse congestive phenomenon.