More than a year-and-a-half following the first near-total face and upper jaw transplant, the donor tissue appears successfully integrated, according to a report in the November/December issue of Archives of Facial Plastic Surgery. The recipient has experienced no long-term rejection and has regained some functional abilities, including her senses of smell and taste.
Three previous facial transplants were completed prior to this procedure, performed at Cleveland Clinic in December 2008. Unlike these, the current procedure was performed on a patient who had already undergone 23 major reconstructive procedures following a gunshot wound to the face. The extensive damage from postoperative scarring and depletion of blood vessels added a complexity to this surgery.
Therefore, a complete vascular workup of the recipient was completed before the procedure. A computed tomographic angiogram of the patient's neck was performed to determine which arteries were intact and which were damaged and could not be used. These vascular considerations and other anatomical characteristics of the recipient, like the fact that she had no nasal septum or structure or upper jaw, guided the surgeons' plan for removing the donor facial tissue.
Initially, it was unclear whether the entire donor tissue (including the upper jaw) could be supplied with blood through only facial arteries, as this approach has not previously been described. Additionally, the microscopic intersections of blood vessels in the jaw made it difficult for the surgeons to dissect and connect them. The authors reported that due to the bleeding from the donor tissue during surgery, they were confident that the blood supply from the facial arterial system was sufficient.
The procedure involved transferring bone and ligaments so that the patient would not experience facial paralysis in the future and would also not require further procedures to elevate facial tissues. As of July 2009, the patient had experienced no surgical complications, has tolerated the immunosuppressive therapy required to keep her body from rejecting the transplant and has obtained significant functional benefits. She can breathe through her nose, eat by mouth and has had significant improvement in her speech.
An additional procedure to remove extra glandular tissue is planned for the future, after the patient regains function of the facial nerve. The successful procedure raises the possibility that future transplants with such large areas of tissue are possible.