Near-total human face transplantation for a severely disfigured patient in the USA

作者：Siemionow Maria^*; Papay Frank; Alam Daniel; Bernard Steven; Djohan Risal; Gordon Chad; Hendrickson Mark; Lohman Robert; Eghtesad Bijan; Coffman Kathy; Kodish Eric; Paradis Carmen; Avery Robin; Fung John

来源：Lancet, 2009, 374(9685): 203-209.

DOI：10.1016/S0140-6736(09)61155-7

Background Multiple reconstructive procedures are common for the reconstruction of complex facial deformities of skin, soft tissues, bony structures, and functional subunits, such as the nose, lips, and eyelids. However, the results have been unsatisfactory. An innovative approach entailing a single surgical procedure of face allograft transplantation is a viable alternative and gives improved results.
Methods On Dec 9, 2008, a 45-year-old woman with a history of severe midface trauma underwent near-total face transplantation in which 80% of her face was replaced with a tailored composite tissue allograft. We addressed issues of immunosuppressive therapy, psychological and ethical outcomes, and re-integration of the patient into society.
Findings After the operation, the patient did well physically and psychologically, and tolerated immunosuppression without any major complication. Routine biopsy on day 47 after transplantation showed rejection of graft mucosa; however, a single bolus of corticosteroids reversed rejection. During the first 3 weeks after transplantation, the patient accepted her new face; 6 months after surgery, the functional outcome has been excellent. In contrast to her status before transplantation, the patient can now breathe through her nose, smell, taste, speak intelligibly, eat solid foods, and drink from a cup.
Interpretation We show the feasibility of reconstruction of severely disfigured patients in a single surgical procedure using composite face allotransplantation. Therefore, this should be taken in consideration as an early option for severely disfigured patients.

• 出版日期2009-7-18
• 单位河北医科大学