Facial composite tissue allograft

The Journal of Craniofacial Surgery
Bohdan Pomahac, Julian J Pribaz

Abstract

Despite complex facial anatomy, transplantation of soft tissues of the entire face, including the maxilla and mandibular segment anterior to the masseter muscle insertion, can be safely performed based on facial vessels alone. Inclusion of hair-bearing scalp requires dissection of the superficial temporal vessels. Unlike other groups, we advocate for supercharging dissected superficial temporal vessels in the preauricular area avoiding difficult dissections in the depth of external auditory canal that presents significant challenges associated with lengthy dissection and bleeding. Neurorrhaphy at the trunk of the facial nerve leads to less targeted postoperative reinnervation, with potential for synkinesis, and whenever possible, individual peripheral facial nerve branches should be reconnected. Adequate planning for integration of the facial allograft requires both complete sensory and motor nerve connection and should be part of each operation. Bilateral external carotid anastomosis may cause a variety of functional problems including oropharyngeal dysfunction and ocular ischemia and hence is not recommended.

References

Jan 1, 1980·The Journal of Hand Surgery·M E JabaleyF R Heckler
Jun 9, 2000·Plastic and Reconstructive Surgery·N D HousemanW R Pan
Jan 22, 2002·Biological Psychiatry·James V HaxbyM Ida Gobbini

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Citations

Aug 17, 2012·Current Opinion in Otolaryngology & Head and Neck Surgery·Kumaran ShanmugarajahPeter E M Butler
Sep 27, 2012·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Juan P Barret, Jordi Serracanta
May 8, 2013·Journal of Plastic Surgery and Hand Surgery·Nicholas BastidasJesse A Taylor
Mar 26, 2014·Archives of Plastic Surgery·Seok Chan Eun
Dec 3, 2013·Craniomaxillofacial Trauma & Reconstruction·Pamela R Brown BaerColonel Robert G Hale
Oct 27, 2016·Plastic and Reconstructive Surgery·Julie E Park, David W Chang
Sep 26, 2014·Plastic and Reconstructive Surgery·Maximilian KueckelhausBohdan Pomahac

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