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Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment
BACKGROUND: In properly selected patients, combined face and whole eye transplantation (FWET) may offer a more optimal aesthetic and potentially functional outcome while avoiding the complications and stigma of enucleation and prosthetics. This study presents the most comprehensive cadaveric assessm...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10653600/ https://www.ncbi.nlm.nih.gov/pubmed/38025647 http://dx.doi.org/10.1097/GOX.0000000000005409 |
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author | Brydges, Hilliard T. Onuh, Ogechukwu C. Chaya, Bachar F. Tran, David L. Cassidy, Michael F. Dedania, Vaidehi S. Ceradini, Daniel J. Rodriguez, Eduardo D. |
author_facet | Brydges, Hilliard T. Onuh, Ogechukwu C. Chaya, Bachar F. Tran, David L. Cassidy, Michael F. Dedania, Vaidehi S. Ceradini, Daniel J. Rodriguez, Eduardo D. |
author_sort | Brydges, Hilliard T. |
collection | PubMed |
description | BACKGROUND: In properly selected patients, combined face and whole eye transplantation (FWET) may offer a more optimal aesthetic and potentially functional outcome while avoiding the complications and stigma of enucleation and prosthetics. This study presents the most comprehensive cadaveric assessment for FWET to date, including rehearsal allograft procurement on a brain-dead donor. METHODS: Over a 2-year period, 15 rehearsal dissections were performed on 21 cadavers and one brain-dead donor. After identification of a potential recipient, rehearsals assessed clinical feasibility and enabled operative planning, technical practice, refinement of personalized equipment, and improved communication among team members. Operative techniques are described. RESULTS: Facial allograft procurement closely followed previously described face transplant techniques. Ophthalmic to superficial temporal (O-ST) vessel anastomosis for globe survival was assessed. Craniectomy allowed for maximal optic nerve and ophthalmic vessel pedicle length. Appropriate pedicle length and vessel caliber for O-ST anastomosis was seen. Research procurement demonstrated collateral blood flow to the orbit and surrounding structures from the external carotid system as well as confirmed the feasibility of timely O-ST anastomosis. Personalized cutting guides enabled highly accurate bony inset. CONCLUSIONS: This study formalizes an approach to FWET, which is feasible for clinical translation in judiciously selected patients. O-ST anastomosis seems to minimize retinal ischemia time and allow perfusion of the combined allograft on a single external carotid pedicle. Although restoration of vision likely remains out of reach, globe survival is possible. |
format | Online Article Text |
id | pubmed-10653600 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-106536002023-11-16 Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment Brydges, Hilliard T. Onuh, Ogechukwu C. Chaya, Bachar F. Tran, David L. Cassidy, Michael F. Dedania, Vaidehi S. Ceradini, Daniel J. Rodriguez, Eduardo D. Plast Reconstr Surg Glob Open Research BACKGROUND: In properly selected patients, combined face and whole eye transplantation (FWET) may offer a more optimal aesthetic and potentially functional outcome while avoiding the complications and stigma of enucleation and prosthetics. This study presents the most comprehensive cadaveric assessment for FWET to date, including rehearsal allograft procurement on a brain-dead donor. METHODS: Over a 2-year period, 15 rehearsal dissections were performed on 21 cadavers and one brain-dead donor. After identification of a potential recipient, rehearsals assessed clinical feasibility and enabled operative planning, technical practice, refinement of personalized equipment, and improved communication among team members. Operative techniques are described. RESULTS: Facial allograft procurement closely followed previously described face transplant techniques. Ophthalmic to superficial temporal (O-ST) vessel anastomosis for globe survival was assessed. Craniectomy allowed for maximal optic nerve and ophthalmic vessel pedicle length. Appropriate pedicle length and vessel caliber for O-ST anastomosis was seen. Research procurement demonstrated collateral blood flow to the orbit and surrounding structures from the external carotid system as well as confirmed the feasibility of timely O-ST anastomosis. Personalized cutting guides enabled highly accurate bony inset. CONCLUSIONS: This study formalizes an approach to FWET, which is feasible for clinical translation in judiciously selected patients. O-ST anastomosis seems to minimize retinal ischemia time and allow perfusion of the combined allograft on a single external carotid pedicle. Although restoration of vision likely remains out of reach, globe survival is possible. Lippincott Williams & Wilkins 2023-11-16 /pmc/articles/PMC10653600/ /pubmed/38025647 http://dx.doi.org/10.1097/GOX.0000000000005409 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Research Brydges, Hilliard T. Onuh, Ogechukwu C. Chaya, Bachar F. Tran, David L. Cassidy, Michael F. Dedania, Vaidehi S. Ceradini, Daniel J. Rodriguez, Eduardo D. Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment |
title | Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment |
title_full | Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment |
title_fullStr | Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment |
title_full_unstemmed | Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment |
title_short | Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment |
title_sort | combined face and whole eye transplantation: cadaveric rehearsals and feasibility assessment |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10653600/ https://www.ncbi.nlm.nih.gov/pubmed/38025647 http://dx.doi.org/10.1097/GOX.0000000000005409 |
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