Face Transplantation

Abstract

Penetrating trauma, burns, congenital disorders, and tumor excision can cause complex wounds involving several different types of tissue, leading to severe facial disfigurement. Patients may lose the ability to eat, smell, breathe, speak, and see normally. Often these patients require a permanent feeding tube and tracheotomy. Equally important, patients also lose the ability to communicate their emotions to others by way of their facial expressions. These circumstances lead to diminished feelings of self-worth and social isolation. Prior to the era of facial transplantation, reconstruction of major facial defects involved a prolonged series of challenging operations that typically combined various types of flaps, grafts, and prosthetic material. Patients were commonly subjected to dozens of operations. Aside from the need for multiple operations, other major drawbacks to this approach include expense, frequent complications, and the need for multiple flap and graft donor sites. Furthermore, the results of staged reconstruction, especially for central facial defects, are often so poor that patients frequently withdraw from routine social interactions. Writing in 2002 on the pages of The Lancet, Peter Butler called attention to this problem and wondered if transplantation was “fantasy or the future” for facial reconstruction [1].