Facial allograft transplantation: fiction or reality? Surgical techniques in a fresh human cadaver model

The aim of this study was to describe two methods of face-harvesting techniques - a skin and soft tissue flap and a combined osteocutaneous flap - and to demonstrate the compatibility between donor and recipient in a human fresh cadaver model. In fresh human cadavers the skin and soft tissue of the face (type 1) and a combined osteocutaneous flap (including a le Fort III segment, type 2) were harvested. The faces were subsequently exchanged among the donor crania, simulating full-face transplantation. Both flaps are based on the external blood supply of the faciotemporal vessels and the external jugular vein. The end branches of the trigeminal nerve could potentially be used for restoration of sensation (type 1 flap). With type 2 flaps the facial expression may be restored with the inclusion of the facial nerve. Four morphological parameters determine the donor/recipient compatibility: skin color and texture, anthropometric head dimensions, specific soft tissue components (nose, lip, cheek, and eyebrow), and gender. Apart from ethical considerations, long-term immunosuppression will remain the limiting factor of full facial transplantation in the near future. © 2007 Springer Medizin Verlag.