PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Facial Transplantation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed2006

Investigation of risk acceptance in facial transplantation.

BACKGROUND: The surgical techniques necessary to transplant a human face are well established, and the early success of human hand transplants suggests that the immunological hurdles of transplanting human facial tissues have largely been overcome. Therefore, it is the ethical barriers that pose the greatest challenge to performing facial transplantation. At the center of the ethical debate is the question, "Do the risks posed by the life-long immunosuppression that a recipient would have to take justify the benefits of receiving a face transplant?" In this study, the authors answer this question by assessing the degree of risk individuals would be willing to accept to receive a face transplant. METHODS: To quantitatively assess risks versus benefits in facial transplantation, the authors developed the Louisville Instrument for Transplantation, or LIFT, which contains 237 standardized questions. Respondents in three study populations (healthy individuals, n = 150; organ transplant recipients, n = 42; and individuals with facial disfigurement, n = 34) were questioned about the extent to which they would trade off specific numbers of life-years, or sustain other costs, in exchange for receiving seven different transplant procedures. RESULTS: The authors found that the three populations would accept differing degrees of risk for the seven transplant procedures. Organ transplant recipients were the most risk-tolerant group, while facially disfigured individuals were the least risk tolerant. All groups questioned would accept the highest degree of risk to receive a face transplant compared with the six other procedures. CONCLUSIONS: This study presents an empirical basis for assessing risk versus benefit in facial transplantation. In doing so, it provides a more solid foundation upon which to introduce this exciting new reconstructive modality into the clinical arena.

Decision Making↗
PubMed2006

Informed consent for facial transplantation.

Now that partial face transplantation has been performed, attention is focused on likely functional, aesthetic and immunological outcomes, and full facial transplantation is the likely next step. Facial transplantation has been the source of ethical debate, a key part of which focuses on valid informed consent. We review the process of informed consent in health settings, assessing how applicable the current standards are for facial transplantation. The factors which need to be assessed during the screening programme are outlined. We conclude that both individual and process factors are important in obtaining consent for radical new procedures, and outline our own gold standard for ensuring informed consent in facial transplantation.

Consent Forms↗
PubMed2005

Facial transplantation: adding to the reconstructive options after severe facial injury and disease.

The ability to reconstruct complex facial injuries is still a considerable challenge despite the development of microsurgical techniques. The reconstructive options for conditions such as panfacial burns are severely limited. The result after multiple surgical procedures in this group is often poor in terms of function and cosmesis. Facial transplantation provides a potential solution, but opinion is currently divided about the extent to which the potential benefits to the quality of life can be justified when weighed against the technical, psychological and immunological risks. This paper reviews the current status of the debate and argues that a rigorous research strategy is the only logical basis for countering the ethical objections to a procedure that offers considerable benefits over existing reconstructive options.

Face↗
PubMed2006

Facial transplantation: a comprehensive review of the literature.

PURPOSE: Composite tissue allotransplantation has become a clinical reality and a major breakthrough in reconstructive surgery. The current boundary of dispute on composite tissue allotransplantation is regarding the full-face transplantation. The aim of this article is to provide a comprehensive overview of how facial allotransplantation has been approached in the scientific literature. MATERIAL AND METHODS: The selection of articles was conducted using PubMed at between January 2000 and September 2005. The search terms were "facial graft," "facial transplantation," and "facial allotransplant." The criteria of analysis were the category of articles and the presence of 6 items: 1) issues regarding the donor; 2) psychological impact on the recipient; 3) surgical risks; 4) immunologic risks; 5) socio-cultural aspects; and 6) expense. RESULTS: Thirty-eight articles were included. The first article was published in 2002. Most articles over the last 4 years dealt with issues of medical ethics. The annual rate of basic research articles was relatively stable. Conversely, the rate of 'view points,' notably regarding ethics aspects, increased dramatically in 2004. The issues regarding the donor were found in 26% of the articles, the psychological echo on the recipient in 53% of the articles but in 81% of the medical ethics papers, the immunologic risks in 81% of the articles, the surgical risks in 66% of the articles, socio-cultural aspects in 34% of the articles, and expense problems in 5% of the articles. CONCLUSION: Psychological, immunologic, and surgical risks are the problems addressed most in the literature. Cost, donor, social, and cultural aspects are least addressed. There is a lack of hard data in the literature regarding those problems.

Bibliometrics↗
PubMed2004

On the ethics of facial transplantation research.

Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase.

Body Image↗
PubMed2005

New surgical approach in facial transplantation extends survival of allograft recipients.

We have previously developed a composite total face-scalp allotransplantation model based on bilateral common carotid arteries (CCA) and external jugular veins. To decrease the mortality rates, different modifications of arterial anastomoses in the facial allograft recipients are presented. Eighteen full face-scalp allograft transplantations were performed across major histocompatibility (MHC) barriers between ACI (RT1) donors and Lewis (RT1) recipients. Bilateral CCA and bilateral external carotid arteries of the recipients were used as recipient vessels to vascularize the flap in 5 and 4 transplants, respectively. In 9 transplants, unilateral CCA of the recipients were used to vascularize the face/scalp flap. All the animals received CsA 16 mg/kg/d Sc, which was tapered over 4 weeks to 2 mg/kg/d. In transplants utilizing bilateral CCA, the survival rate of the animals was very short. Transplants in which unilateral CCA were used yielded 100% survivals over 200 days posttransplant. These modifications of arterial anastomoses have significantly improved survival of facial allograft recipients.

Anastomosis, Surgical↗
PubMed2006

A cadaver study in preparation for facial allograft transplantation in humans: part II. Mock facial transplantation.

BACKGROUND: The authors have performed mock facial transplantation by harvesting total facial-scalp flaps from donors and transferring them to recipient cadavers. METHODS: A total of 10 fresh human cadavers were dissected. In the donor, the authors have measured the time of facial-scalp flap harvesting, and the length of the arterial and venous pedicles and sensory nerves that were included in the facial flaps. In the recipient, the authors have evaluated the time of facial skin harvest as a monobloc full-thickness graft, the anchoring regions for the inset of the donor facial flaps, and the time sequences for the vascular pedicle anastomoses and nerve coaptations. RESULTS: In the donor cadaver, the mean harvesting time of the total facial-scalp flap harvest was 235.62 +/- 21.94 minutes. The mean length of the supraorbital, infraorbital, mental, and great auricular nerves was 1.5 +/- 0.15, 2.46 +/- 0.25, 3.02 +/- 0.31, and 6.11 +/- 0.42 cm, respectively. The mean length of the external carotid artery, the facial vein, and external jugular vein was 5 +/- 0.32, 3.15 +/- 0.32, and 5.78 +/- 0.5 cm, respectively. In the recipient cadaver, the mean harvesting time of facial skin as a monobloc full-thickness graft was 47.5 +/- 3.53 minutes. The mean time for the preparation of the arterial and venous pedicles and sensory nerves for the future anastomoses and coaptation was 30 +/- 0 minutes. The mean time for facial flap anchoring was 22.5 +/- 3.53 minutes. The total mean time of facial mock transplantation without vessels and nerve repair was 320 +/- 7.07 minutes (5 hours 20 minutes). CONCLUSION: Based on anatomical dissections in this cadaver study, the authors have estimated the time and sequence of facial flap harvest and inset to mimic the clinical scenario of the facial transplantation procedure.

Aged↗