Guidelines and Technical Aspects in Face Composite Tissue Transplantation

  • Frank Papay


Face transplantation combines the surgical complexity of multiple subspecialties that require an organized systematic approach to the evaluation of potential face transplant candidates, donors and surgical team members. Once established, the face transplant team should comprise of the scientific, clinical and surgical expertise than can orchestrate a successful operation on a well chosen patient. Our efforts at the Cleveland Clinic’s Department of Plastic Surgery first face transplantation procedure revealed guidelines and technical aspects in facial composite tissue transplantation that can guide other institutions in their efforts to expand composite tissue transplantation as not just a state-of-the-art surgery but rather the future standard of care for those debilitated patients that have exhausted all facets of facial reconstruction. This chapter is meant as only a guideline since each subsequent face transplantation patient will require a custom made surgical approach to both the donor face delivery and transplant procedure.


Facial Nerve Orbital Floor Facial Artery Infraorbital Nerve Transplant Team 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Devauchelle B, Badet L, Lengele B, et al. First human face allograft: early report. Lancet. 2006;368:203-209.PubMedCrossRefGoogle Scholar
  2. 2.
    Dubernard JM, Devauchelle B. Face transplantation. Lancet. 2008;372:603-604.PubMedCrossRefGoogle Scholar
  3. 3.
    Dubernard JM, Lengele B, Morelon E, et al. Outcomes 18 months after the first human partial face transplantation. N Engl J Med. 2007;357:2451-2460.PubMedCrossRefGoogle Scholar
  4. 4.
    Kanitakis J, Badet L, Petruzzo P, et al. Clinicopathologic monitoring of the skin and oral mucosa of the first human face allograft: report on the first eight months. Transplantation. 2006;82:1610-1615.PubMedCrossRefGoogle Scholar
  5. 5.
    Lantieri L, Meningaud JP, Grimbert P, et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet. 2008;372:639-645.PubMedCrossRefGoogle Scholar
  6. 6.
    Lengele BG, Testelin S, Dakpe S, et al. “Facial graft”: about the first facial allotransplantation of composite tissues [in French]. Ann Chir Plast Esthét. 2007;52:475-484.PubMedGoogle Scholar
  7. 7.
    Siemionow M, Papay F, Alam D, et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet. 2009;374:203-209.PubMedCrossRefGoogle Scholar
  8. 8.
    Houseman ND, Taylor GI, Pan WR. The angiosomes of the head and neck: anatomic study and clinical applications. Plast Reconstr Surg. 2000;105:2287-2313.PubMedCrossRefGoogle Scholar
  9. 9.
    Cordeiro PG, Disa JJ. Challenges in midface reconstruction. Semin Surg Oncol. 2000;19:218-225.PubMedCrossRefGoogle Scholar
  10. 10.
    Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg. 2000;105:2331-2346. Discussion 2347-2348.PubMedCrossRefGoogle Scholar
  11. 11.
    Parrett BM, Pomahac B, Orgill DP, Pribaz JJ. The role of free-tissue transfer for head and neck burn reconstruction. Plast Reconstr Surg. 2007;120:1871-1878.PubMedCrossRefGoogle Scholar
  12. 12.
    Pribaz JJ, Weiss DD, Mulliken JB, Eriksson E. Prelaminated free flap reconstruction of complex central facial defects. Plast Reconstr Surg. 1999;104:357-365.PubMedCrossRefGoogle Scholar
  13. 13.
    Yazici I, Cavusoglu T, Comert A, et al. Maxilla allograft for transplantation: an anatomical study. Ann Plast Surg. 2008;61:105-513.PubMedCrossRefGoogle Scholar
  14. 14.
    Takamatsu A, Harashina T, Inoue T. Selection of appropriate recipient vessels in difficult, microsurgical head and neck reconstruction. J Reconstr Microsurg. 1996;12:499-507. Discussion 508-513.PubMedCrossRefGoogle Scholar
  15. 15.
    Wilhelmi BJ, Kang RH, Movassaghi K, Ganchi PA, Lee WP. First successful replantation of face and scalp with single-artery repair: model for face and scalp transplantation. Ann Plast Surg. 2003;50:535-540.PubMedCrossRefGoogle Scholar
  16. 16.
    Meningaud JP, Paraskevas A, Ingallina F, Bouhana E, Lantieri L. Face transplant graft procurement: a preclinical and clinical study. Plast Reconstr Surg. 2008;122:1383-1389.PubMedCrossRefGoogle Scholar
  17. 17.
    Dodson TB, Bays RA, Neuenschwander MC. Maxillary perfusion during Le Fort I osteotomy after ligation of the descending palatine artery. J Oral Maxillofac Surg. 1997;55:51-55.PubMedCrossRefGoogle Scholar
  18. 18.
    Siebert JW, Angrigiani C, McCarthy JG, Longaker MT. Blood supply of the Le Fort I maxillary segment: an anatomic study. Plast Reconstr Surg. 1997;100:843-851.PubMedCrossRefGoogle Scholar
  19. 19.
    Banks ND, Hui-Chou HG, Tripathi S, et al. An anatomical study of external carotid artery vascular territories in face and midface flaps for transplantation. Plast Reconstr Surg. 2009;123:1677-1687.PubMedCrossRefGoogle Scholar
  20. 20.
    Lanzetta M, Petruzzo P, Dubernard JM, et al. The Second Report (1998–2006) of the International Registry of Hand and Composite Tissue Transplantation. Transpl Immunol. 2007;18:1-6.PubMedCrossRefGoogle Scholar
  21. 21.
    Nation’s fourth hand transplant performed at Jewish Hospital Hand Care Center by Kleinert Kutz and University of Louisville Surgeons. 2008, July 12.Hand Transplant July 12, 2008.
  22. 22.
    Gorantla VS, Breidenbach WC. Hand transplantation: the Louisville experience. In: Hewitt CW, Lee WPA, Gordon CR, eds. Transplantation of Composite Tissue Allografts. New York: Springer; 2008:215-233.CrossRefGoogle Scholar
  23. 23.
    International Registry of Hand and Composite Tissue Transplantation. Hand Registry home page. Accessed April 6, 2008.
  24. 24.
    Lanzetta M, Petruzzo P, Margreiter R, et al. The international registry on hand and composite tissue transplantation. Transplantation. 2005;79(9):1210-1214.PubMedCrossRefGoogle Scholar
  25. 25.
    Dubernard JM. Composite tissue allografts: a challenge for transplantologists. Am J Transplant. 2005;5:1580-1581.PubMedCrossRefGoogle Scholar
  26. 26.
    Schneeberger S, Ninkovic M, Margreiter R. Hand transplantation: the Innsbruck experience. In: Hewitt CW, Lee WPA, Gordon CR, eds. Transplantation of Composite Tissue Allografts. New York: Springer; 2008:193-208.Google Scholar
  27. 27.
    Petruzzo P, Morelon E, Kanitakis J, et al. Hand transplantation: the Lyon experience. In: Hewitt CW, Lee WPA, Gordon CR, eds. Transplantation of Composite Tissue Allografts. New York: Springer; 2008:209-214.CrossRefGoogle Scholar
  28. 28.
    Lee WP, Sacks JM, Horibe EK. World experience of hand transplantation independent assessment. In: Hewitt CW, Lee WPA, Gordon CR, eds. Transplantation of Composite Tissue Allografts. New York: Springer; 2008.Google Scholar
  29. 29.
    Ploplys E, Mathes D. Survey on current attitudes towards composite tissue transplantation in north america among hand surgeons. Plast Reconstr Surg. 2008;121(6S):92.Google Scholar

Copyright information

© Springer London 2011

Authors and Affiliations

  1. 1.Dermatology and Plastic Surgery InstituteCleveland ClinicClevelandUSA

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