Face allotransplantation for various types of facial disfigurements: A series of five cases.

Background: The aim of this report is to present our long-term experiences with a series of 5 face-transplanted patients in terms of surgical aspects and postoperative outcomes, and to describe possible salvage strategies in case of difficulties.

Methods: Five patients, 4 receiving full-face transplantation and 1 undergoing partial transplantation at our institution were included. The patients were aged between 19 and 54 years. Two had extensive burn scars to the face, and 3 had suffered gunshot injuries. The post-transplant induction immunosuppressive regimen included ATG combined with tacrolimus, mycophenolate mofetil, and prednisone, while maintenance was provided by the last 3. We focused on patient summaries including their etiologies, preoperative preparations, surgical techniques, immunosuppressive regimen, postoperative courses, revisional surgeries, together with challenges including acute rejection episodes, and immunosuppressive drug complications.

Results: No re-surgery due to vascular compromise was required in any case. One of the 5 patients was eventually lost due to complicated infectious and metabolic events at the end of post-transplantation month 11. The other 4 patients were still alive, with a mean follow-up time of 53 months and had satisfactory functional transplants and cosmetic appearance.

Conclusions: Face transplantation still involves challenges and many issues including compliance and psychological maturity of patients, the risk of opportunistic infections and malignancies still need to be resolved for it to be accepted as a safe procedure. Surgical rescue procedures considering ideal timing should be kept in mind strictly as one of the most important issues in case of unexpected events.