gms | German Medical Science

46. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 20. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)

01.10. - 03.10.2015, Berlin

Transformation of Face Transplants: Volumetric and Morphologic Graft Changes Resemble Aging after Facial Allotransplantation

Meeting Abstract

  • presenting/speaker Maximilian Kueckelhaus - Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
  • Marvee Turk - Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
  • Sebastian Fischer - Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Plastic Surgery, BG University Hospital Ludwigshafen, Heidelberg University, Ludwigshafen, Germany
  • Kanako Kumamaru - Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
  • Luccie Wo - Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
  • Ericka M Bueno - Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
  • Christine Lian - Department of Pathology, Division of Dermatopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
  • Umberto De Girolami - Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
  • George F Murphy - Department of Pathology, Division of Dermatopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
  • Tobias Hirsch - Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
  • Frank J Rybicki - Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
  • Bohdan Pomahac - Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 46. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 20. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Berlin, 01.-03.10.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc059

doi: 10.3205/15dgpraec059, urn:nbn:de:0183-15dgpraec0592

Published: September 28, 2015

© 2015 Kueckelhaus et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: Facial allotransplantation restores normal anatomy to severely disfigured faces. Although the 28 operations performed worldwide have yielded promising short-term results, long-term outcomes data remain scarce. Three full face transplant recipients were followed for 40 months. Severe changes in volume and composition of the facial allografts were noted.

Methods: All patients provided written informed consent to participate in the clinical trial for face transplantation (ClinicalTrials.gov, NCT01281267). Data from computed tomography performed 6, 18 and 36 months after transplantation were processed to separate the allograft and recipient tissues. Allograft tissues were further separated into bone, fat and non-fat soft tissues. Maximum Intensity Projection (MIP) images were used to assess soft tissue thickness. Skin and muscle biopsies obtained at protocol time points underwent diagnostic evaluation.

Results: All three facial allografts sustained significant volume loss (mean: 19.55%) between 6 and 36 months post-transplant, to an extent that depended on the tissue components. Bone and non-fat soft tissue volumes decreased significantly over time (17.22% between months 6-18 and 25.56% between months 6-36, respectively), while fat did not. MIP images revealed morphometric changes in soft tissues. Histological evaluations showed atrophy of muscle fibers, but no significant decreases in epidermal thickness.

Discussion: Volumetric and morphometric changes in facial allografts have not been previously reported. The transformation of facial allografts in this study resembles aging through volume loss, but differs substantially from regular aging. There is no epidermal thinning or atrophy of fat compartments, but rather loss of bone and non-fat soft tissue. These findings may have far reaching implications for post-transplant treatments aimed at counteracting muscle and bone atrophy.