BACKGROUND: Facial vascularized composite allotransplantation (fVCA) represents a reconstructive approach that enables superior improvements in functional and esthetic restoration compared with conventional craniomaxillofacial reconstruction. Outcome reports of fVCA are usually limited to short-term follow-up or single-center experiences. We merge scientific literature on reported long-term outcome data to better define the risks and benefits of fVCA. METHODS: We conducted a systematic review of PubMed/MEDLINE databases in accordance with PRISMA guidelines. English full-text articles providing data on at least 1 unique fVCA patient, with ≥3 years follow-up, were included. RESULTS: The search yielded 1812 articles, of which 28 were ultimately included. We retrieved data on 23 fVCA patients with mean follow-up of 5.3 years. More than half of the patients showed improved quality of life, eating, speech, and motor and sensory function following fVCA. On average, the patients had 1 acute cell-mediated rejection and infectious episode per year. The incidence rates of acute rejection and infectious complications were high within first-year posttransplant but declined thereafter. Sixty-five percent of the patients developed at least 1 neoplastic or metabolic complication after transplantation. Chronic vascular rejection was confirmed in 2 patients, leading to allograft loss after 8 and 9 years. Two patient deaths occurred 3.5 and 10.5 years after transplant due to suicide and lung cancer, respectively. CONCLUSIONS: Allograft functionality and improvements in quality of life suggest a positive risk-benefit ratio for fVCA. Recurrent acute rejection episodes, chronic rejection, immunosuppression-related complications, and heterogeneity in outcome reporting present ongoing challenges in this field.
- MeSH
- dospělí MeSH
- homologní transplantace MeSH
- imunosupresiva terapeutické užití MeSH
- infekce etiologie MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- rejekce štěpu MeSH
- transplantace obličeje škodlivé účinky psychologie MeSH
- výzkumný projekt MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
Importance: Limited quantitative data exist on the restoration of nonverbal communication via facial emotional expression after face transplant. Objective and noninvasive methods for measuring outcomes and tracking rehabilitation after face transplant are lacking. Objective: To measure emotional expression as an indicator of functional outcomes and rehabilitation after face transplant via objective, noninvasive, and nonobtrusive software-based video analysis. Design, Setting, and Participants: This single-center case-control study analyzed videos with commercially available video analysis software capable of detecting emotional expression. The study participants were 6 patients who underwent face transplant at Brigham and Women's Hospital between April 2009 and March 2014. They were matched by age, race/ethnicity, culture, and sex to 6 healthy controls with no prior facial surgical procedures. Participants were asked to perform either emotional expressions (direct evaluation) or standardized facial movements (indirect evaluation). Videos were obtained in a clinical setting, except for direct evaluation videos of 3 patients that were recorded at the patients' residences. Data analysis was performed from June 2018 to November 2018. Main Outcomes and Measures: The possibility of detecting the emotional expressions of happiness, sadness, anger, fear, surprise, and disgust was evaluated using intensity score values between 0 and 1, representing expressions that are absent or fully present, respectively. Results: Six patients underwent face transplant (4 men; mean [SD] age, 42 [14] years). Four underwent full face transplants, and 2 underwent partial face transplants of the middle and lower two-thirds of the face. In healthy controls, happiness was the only emotion reliably recognized in both indirect (mean [SD] intensity score, 0.92 [0.05]) and direct (mean [SD] intensity score, 0.91 [0.04]) evaluation. Indirect evaluation showed that expression of happiness significantly improved 1 year after transplant (0.04 point per year; 95% CI, 0.02 to 0.06 point per year; P = .002). Expression of happiness was restored to a mean of 43% (range, 14% to 75%) of that of healthy controls after face transplant. The expression of sadness showed a significant change only during the first year after transplant (-0.53 point per year; 95% CI, -0.82 to -0.24 point per year; P = .005). All other emotions were detectable with no significant change after transplant. Nearly all emotions were detectable in long-term direct evaluation of 3 patients, with expression of happiness restored to a mean of 26% (range, 5% to 59%) of that of healthy controls. Conclusions and Relevance: Partial restoration of facial emotional expression is possible after face transplant. Video analysis software may provide useful clinical information and aid rehabilitation after face transplant.
- MeSH
- biometrická identifikace přístrojové vybavení MeSH
- časové faktory MeSH
- dospělí MeSH
- emoce * MeSH
- hodnocení výsledků zdravotní péče metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- studie případů a kontrol MeSH
- transplantace obličeje psychologie MeSH
- výraz obličeje * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
BACKGROUND: The goal of facial transplantation is to transform severely deformed features in a single, complex operation. Although nearly 20 have been completed since 2005, there is limited information about the subsequent psychosocial status of recipients. OBJECTIVE: The purpose of this study is to describe such changes as captured on a variety of psychosocial measures 3 and 6 months after full facial transplantation among 3 adults who all completed a comprehensive psychiatric assessment before the procedure. RESULTS: We hypothesized and found that participants experienced significant improvement on quality of life measures of physical and mental health based on the MOS-SF -12. While the recipients experienced a decline in their physical quality of life in the 3 months immediately after surgery, they had improvement by 6 months (p = 0.02). Overall mental health showed steady improvement from the time before surgery to 6 months later (p = 0.04). These changes, however, were not reflected in another popular measure of quality of life, the EQ-5D. There were no changes in participants ' self-esteem or dyadic function over the same period of time. CONCLUSION: As facial transplantation evolves from being a novel surgical procedure to an increasingly common clinical practice, future efforts to delineate the psychosocial changes experienced by recipients might include mixed methods analyses, with both qualitative and quantitative data, as well as collaborative assessment protocols shared among facial transplantation programs.
- MeSH
- adaptace psychologická * MeSH
- časové faktory MeSH
- dospělí MeSH
- hodnocení výsledků zdravotní péče metody statistika a číselné údaje MeSH
- interpersonální vztahy MeSH
- interview psychologický MeSH
- kvalita života * MeSH
- lidé MeSH
- lineární modely MeSH
- následné studie MeSH
- pooperační období MeSH
- průzkumy a dotazníky MeSH
- psychiatrické posuzovací škály statistika a číselné údaje MeSH
- sebepojetí * MeSH
- transplantace obličeje psychologie rehabilitace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
Facially disfigured blind patients have historically been considered for face transplantation with skepticism. Although no formal position paper regarding their exclusion has been published to date, functional, social, rehabilitative, and ethical concerns related to blind patients' candidacy for face transplantation may be inferred. The authors provide a summary of these reservations and a counterargument to their assumptions, drawing on outcomes measures reported for face transplant procedures performed to date, and their own institutional experience in performing face transplants on blind patients. The authors therefore provide a rationale for the inclusion of facially disfigured blind patients in face transplantation protocols in the future.
- MeSH
- interpersonální vztahy MeSH
- lidé MeSH
- poranění obličeje komplikace psychologie chirurgie MeSH
- poranění oka komplikace psychologie MeSH
- sebepojetí MeSH
- slepota etiologie psychologie MeSH
- transplantace obličeje * etika psychologie rehabilitace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
- MeSH
- dárci tkání MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- počítačová simulace * MeSH
- transplantace obličeje * psychologie MeSH
- věkové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- dopisy MeSH
- práce podpořená grantem MeSH
