First Composite Woman-to-Woman Facial Transplantation in Turkey

Abstract After the first face transplantation from woman to woman we performed in our clinic, it was aimed to eliminate the lack of knowledge about the subject in the literature by transferring our experiences and long-term results to the problems we had with the patient. A 20-year-old patient underwent partial osteomyocutaneous facial transplant (22nd facial transplant), which included 2 functional units of the face. The patient had no major problems in the early period and had a good aesthetic appearance. In the postoperative period, the patient ended her social isolation and adopted the transplanted face. In the late period, secondary surgical interventions, management of the problems caused by immunosuppression, and the patient's living in a remote location to our clinic were the difficulties encountered. Six revision surgeries were performed after the transplantation. Due to immunosuppression, opportunistic infections and metabolic problems required intermittent hospitalization. The patient died at the end of 56 months because of complications secondary to immunosuppression. A successful transplant involves the management of long-term problems rather than a successful tissue transfer in the early period. In today's conditions, long-term success can be achieved with a good patient compliance, as well as each team member should take an active role in the team at the transplantation centers. More case series are needed to adapt the standard treatment and follow-up protocols for solid organ transplantations for composite tissue allotransplantations. This will be possible by sharing the results and experiences transparently in the centers where face transplantation is performed worldwide.

[1]  Facial , 2020, Definitions.

[2]  K. Fındıkçıoğlu,et al.  Before and After: What Has Changed in the Attitude of Turkish Society Regarding Face Transplantations? , 2019, Annals of plastic surgery.

[3]  Rami S. Kantar,et al.  Achievements and Challenges in Facial Transplantation , 2018, Annals of surgery.

[4]  B. Pomahac,et al.  Face transplantation—current status and future developments , 2018, Transplant international : official journal of the European Society for Organ Transplantation.

[5]  Rami S. Kantar,et al.  Face Transplantation: An Update for the United States Trauma System , 2018, The Journal of craniofacial surgery.

[6]  S. Suominen,et al.  The Helsinki Face Transplantation: Surgical aspects and 1-year outcome. , 2017, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[7]  S. Testelin,et al.  Face Transplantation: Partial Graft Loss of the First Case 10 Years Later , 2017, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[8]  Jordan R. Green,et al.  The Effects of Lip-Closure Exercise on Lip Strength and Function Following Full Facial Transplantation: A Case Report. , 2017, American journal of speech-language pathology.

[9]  H. Uysal,et al.  Consideration of difficulties and exit strategies in a case of face allotransplantation resulting in failure , 2017, Microsurgery.

[10]  B. Pomahac,et al.  Reflections on a Decade of Face Transplantation. , 2017, Annals of surgery.

[11]  G. Pafitanis,et al.  A review of the world’s published face transplant cases: ethical perspectives , 2017, Scars, burns & healing.

[12]  M. Siemionow The decade of face transplant outcomes , 2017, Journal of Materials Science: Materials in Medicine.

[13]  E. Rodriguez,et al.  Discussion: Watershed Areas in Face Transplantation. , 2017, Plastic and reconstructive surgery.

[14]  B. Pomahac,et al.  Quality of Life after Face Transplantation: Outcomes, Assessment Tools, and Future Directions , 2017, Plastic and reconstructive surgery.

[15]  Russell S. Frautschi,et al.  Watershed Areas in Face Transplantation. , 2017, Plastic and reconstructive surgery.

[16]  M. Siemionow The miracle of face transplantation after 10 years. , 2016, British medical bulletin.

[17]  E. Caterson,et al.  A Retrospective Analysis of Secondary Revisions after Face Transplantation: Assessment of Outcomes, Safety, and Feasibility , 2016, Plastic and reconstructive surgery.

[18]  Roberto L. Flores,et al.  Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant: A Reconstructive Solution for the Full Face and Total Scalp Burn. , 2016, Plastic and reconstructive surgery.

[19]  E. Rodriguez,et al.  The Face Transplantation Update: 2016 , 2016, Plastic and reconstructive surgery.

[20]  E. Rodriguez,et al.  Face transplantation: Complications, implications, and an update for the oncologic surgeon , 2016, Journal of surgical oncology.

[21]  B. Pomahac,et al.  Intraoral features and considerations in face transplantation. , 2016, Oral diseases.

[22]  S. Testelin,et al.  Clinicopathological Findings of Chronic Rejection in a Face Grafted Patient , 2015, Transplantation.

[23]  B. Pomahac,et al.  Facial transplantation: worth the risks? A look at evolution of indications over the last decade , 2015, Current opinion in organ transplantation.

[24]  S. Testelin,et al.  Premalignant and Malignant Skin Lesions in Two Recipients of Vascularized Composite Tissue Allografts (Face, Hands) , 2015, Case reports in transplantation.

[25]  A. Gülşen,et al.  The Importance of the Condition of the Donor Teeth and Jaws During Allogeneic Face Transplantation. , 2015, The Journal of craniofacial surgery.

[26]  B. Pomahac,et al.  Facial restoration by transplantation: the Brigham and Women's face transplant experience. , 2015, Annals of plastic surgery.

[27]  Xavier Rogiers,et al.  Complex facial reconstruction by vascularized composite allotransplantation: the first Belgian case. , 2015, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[28]  E. Rodriguez,et al.  Eyelid Transplantation: Lessons from a Total Face Transplant and the Importance of Blink , 2015, Plastic and reconstructive surgery.

[29]  B. Pomahac,et al.  Functional Outcomes of Face Transplantation , 2015, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[30]  E. Rodriguez,et al.  Facial transplantation: the first 9 years , 2014, The Lancet.

[31]  Eduardo D Rodriguez,et al.  Principles of Face Transplant Revision: Beyond Primary Repair , 2014, Plastic and reconstructive surgery.

[32]  E. Rodriguez,et al.  Evolving Concepts of Skin and Mucosal Biopsy in Facial Vascularized Composite Allotransplantation , 2014, Current Transplantation Reports.

[33]  M. Heiland,et al.  Face Transplantation: On the Verge of Becoming Clinical Routine? , 2014, BioMed research international.

[34]  A. Rampazzo,et al.  Vascularization of the Facial Bones by the Facial Artery: Implications for Full Face Allotransplantation , 2014, Plastic and reconstructive surgery.

[35]  C. Ensor,et al.  Characterization, Prophylaxis, and Treatment of Infectious Complications in Craniomaxillofacial and Upper Extremity Allotransplantation: A Multicenter Perspective , 2014, Plastic and reconstructive surgery.

[36]  Geoffroy C. Sisk,et al.  Vascular Communications Between Donor and Recipient Tissues After Successful Full Face Transplantation , 2014, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[37]  Amir H Dorafshar,et al.  Aesthetic and Functional Facial Transplantation: A Classification System and Treatment Algorithm , 2014, Plastic and reconstructive surgery.

[38]  B. Pomahac,et al.  Evolution of Ethical Debate on Face Transplantation , 2013, Plastic and reconstructive surgery.

[39]  Daniel S. Alam,et al.  Facial transplantation for massive traumatic injuries. , 2013, Otolaryngologic clinics of North America.

[40]  J. Barret,et al.  LeFort I osteotomy and secondary procedures in full-face transplant patients. , 2013, Journal of plastic, reconstructive & aesthetic surgery : JPRAS.

[41]  B. Pomahac,et al.  Infections Following Facial Composite Tissue Allotransplantation—Single Center Experience and Review of the Literature , 2013, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[42]  E. Rodriguez,et al.  Total Face, Double Jaw, and Tongue Transplantation: An Evolutionary Concept , 2013, Plastic and reconstructive surgery.

[43]  E. Caterson,et al.  Ischemia-Reperfusion Injury in Vascularized Composite Allotransplantation , 2013, The Journal of craniofacial surgery.

[44]  E. Caterson,et al.  Evolution and Limitations of Conventional Autologous Reconstruction of the Head and Neck , 2013, The Journal of craniofacial surgery.

[45]  P. Saadeh,et al.  Achieving Aesthetic Results in Facial Reconstructive Microsurgery: Planning and Executing Secondary Refinements , 2012, Plastic and reconstructive surgery.

[46]  S. Schneeberger,et al.  Mechanisms and Mediators of Inflammation: Potential Models for Skin Rejection and Targeted Therapy in Vascularized Composite Allotransplantation , 2012, Clinical & developmental immunology.

[47]  E. Rodriguez,et al.  The Evolution of Critical Concepts in Aesthetic Craniofacial Microsurgical Reconstruction , 2012, Plastic and reconstructive surgery.

[48]  P. Butler,et al.  Facial transplantation , 2012, Current opinion in otolaryngology & head and neck surgery.

[49]  O. Guntinas-Lichius,et al.  Three patients with full facial transplantation. , 2012, The New England journal of medicine.

[50]  F. Rybicki,et al.  Three patients with full facial transplantation. , 2012, The New England journal of medicine.

[51]  Leonard B Kaban,et al.  Le Fort–Based Maxillofacial Transplantation: Current State of the Art and a Refined Technique Using Orthognathic Applications , 2012, The Journal of craniofacial surgery.

[52]  M. Siemionow,et al.  Face Transplantation: Outcomes, Concerns, Controversies, and Future Directions , 2012, The Journal of craniofacial surgery.

[53]  Can Ozturk,et al.  An Update on Facial Transplantation Cases Performed between 2005 and 2010 , 2011, Plastic and reconstructive surgery.

[54]  X. Nuvials,et al.  Full Face Transplant: The First Case Report , 2011, Annals of surgery.

[55]  Jean-Paul Meningaud,et al.  The Procurement of Allotransplants for Ballistic Trauma: A Preclinical Study and a Report of Two Clinical Cases , 2011, Plastic and reconstructive surgery.

[56]  F. Bellivier,et al.  Feasibility, Reproducibility, Risks and Benefits of Face Transplantation: A Prospective Study of Outcomes , 2011, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[57]  B. Pomahac,et al.  Restoration of Facial Form and Function After Severe Disfigurement from Burn Injury by a Composite Facial Allograft , 2011, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[58]  Ikuo Kageyama,et al.  Clinical anatomy of the maxillary artery. , 2011, Okajimas folia anatomica Japonica.

[59]  S. Miller The World's Experience With Facial Transplantation: What Have We Learned Thus Far? , 2011 .

[60]  P. Butler,et al.  Clinical outcomes of facial transplantation: a review. , 2011, International journal of surgery.

[61]  F. Schuind,et al.  The International Registry on Hand and Composite Tissue Transplantation , 2005, Transplantation.

[62]  Bohdan Pomahac,et al.  Vascular Considerations in Composite Midfacial Allotransplantation , 2010, Plastic and reconstructive surgery.

[63]  Risal Djohan,et al.  First U.S. Near-Total Human Face Transplantation: A Paradigm Shift for Massive Complex Injuries , 2010, Plastic and reconstructive surgery.

[64]  Daniel S. Alam,et al.  The technical and anatomical aspects of the World's first near-total human face and maxilla transplant. , 2009, Archives of facial plastic surgery.

[65]  S. Schneeberger,et al.  The World's Experience With Facial Transplantation: What Have We Learned Thus Far? , 2009, Annals of plastic surgery.

[66]  J. Fung,et al.  Near-total human face transplantation for a severely disfigured patient in the USA , 2009, The Lancet.

[67]  E. Rodriguez,et al.  An Anatomical Study of External Carotid Artery Vascular Territories in Face and Midface Flaps for Transplantation , 2009, Plastic and reconstructive surgery.

[68]  K. Littlewood The immunocompromised adult patient and surgery. , 2008, Best practice & research. Clinical anaesthesiology.

[69]  F. Bellivier,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 , 2008, The Lancet.

[70]  Shuzhong Guo,et al.  Human facial allotransplantation: a 2-year follow-up study , 2008, The Lancet.

[71]  A. Kirk,et al.  The Banff 2007 Working Classification of Skin‐Containing Composite Tissue Allograft Pathology , 2008, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[72]  A. Sirigu,et al.  Outcomes 18 months after the first human partial face transplantation. , 2007, The New England journal of medicine.

[73]  M. Freeman,et al.  Justifying surgery’s last taboo: the ethics of face transplants , 2007, Journal of Medical Ethics.

[74]  Maria Siemionow,et al.  Facial Transplantation , 2007, Seminars in plastic surgery.

[75]  L Doyal,et al.  Facial transplantation: a working party report from the Royal College of Surgeons of England , 2004, Transplantation.

[76]  D. Goldfarb Are wound complications after a kidney transplant more common with modern immunosuppression? , 2002, The Journal of urology.

[77]  A. Matas,et al.  ARE WOUND COMPLICATIONS AFTER A KIDNEY TRANSPLANT MORE COMMON WITH MODERN IMMUNOSUPPRESSION? , 2001, Transplantation.

[78]  G. K. Jain,et al.  A time course study for the development of an immunocompromised wound model, using hydrocortisone. , 1999, Journal of pharmacological and toxicological methods.