Face Reconstruction

  Modern Reconstruction Techniques

Development of microsurgical techniques in the 1970s revolutionized the surgeon's ability to reconstruct complex facial defects reliably. Microsurgical techniques allowed transplantation of autologous tissue (tissue from the same person) with bone, muscle and skin with its own blood supply (called free flaps). Tissue is transferred from one area to another with an immediately viable graft. Microsurgery has come a long way since the first successful rabbit ear replantation by Harry Buncke. Today, these microsurgical techniques combined with a wealth of anatomical knowledge made it possible for surgeons to replant severed body parts by joining up divided blood vessels, nerves and other injured structures.

Microsurgical techniques have made possible the use of composite tissue allografts in hand, face and other soft tissue defects. There were initial concerns with regards to the potential high antigenicity of these tissues especially skin. (1).

However, on the 23rd of September 1998 the first human hand allograft (transplant) was successfully performed by a French team of surgeons in Lyon, France. The operation was a technical success and demonstrated that skin, muscle and bone could be succesfully transplanted with modern immunosuppressive drugs. This encouraged other medical teams around the world to follow suit.

Figures 1 & 2 - A hand transplant and its post-operative result (Images courtesy of Jewish Hospital; Kleinert, Kutz and Associates Hand Care Center; and University of Louisville, http://www.handtransplant.org).

Since then 24 hand allografts have been performed and there have been additional transplantations of other anatomic parts such as the knee joint and larynx (2,3). The early results of these transplants were encouraging with successful prevention of graft rejection using current immunosuppressive programmes. This development rekindled the interest in the possibility of performing face transplants to restore facial form and function in patients where conventional reconstructive techniques have relatively poorer outcomes. (eg. severe burns).