A Retrospective Analysis of Secondary Revisions after Face Transplantation
| Autor: | Ericka M. Bueno, Julian J. Pribaz, Edward J. Caterson, Maximilian Kueckelhaus, Nicco Krezdorn, Mario A. Aycart, Muayyad Alhefzi, Bohdan Pomahac |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty medicine.medical_treatment Context (language use) 030230 surgery 03 medical and health sciences Patient safety 0302 clinical medicine medicine Operative report Humans Facial Injuries Retrospective Studies business.industry Medical record Postoperative complication Immunosuppression Middle Aged Debulking Surgery Transplantation Treatment Outcome 030220 oncology & carcinogenesis Feasibility Studies Female business Facial Transplantation Follow-Up Studies |
| Zdroj: | Plastic and Reconstructive Surgery. 138:690e-701e |
| ISSN: | 0032-1052 |
| DOI: | 10.1097/prs.0000000000002605 |
| Popis: | BACKGROUND Face transplantation has emerged as a viable option for certain patients in the treatment of devastating facial injuries. However, as with autologous free tissue transfer, the need for secondary revisions in face transplantation also exists. The authors' group has quantified the number of revision operations in their cohort and has assessed the rationale, safety, and outcomes of posttransplantation revisions. METHODS A retrospective analysis of prospectively collected data of the authors' seven face transplants was performed from April of 2009 to July of 2015. The patients' medical records, preoperative facial defects, and all operative reports (index and secondary revisions) were critically reviewed. RESULTS The average number of revision procedures was 2.6 per patient (range, zero to five procedures). The median time interval from face transplantation to revision surgery was 5 months (range, 1 to 10 months). Most interventions consisted of debulking of the allograft, superficial musculoaponeurotic system plication and suspension, and local tissue rearrangement. There were no major infections, allograft skin flap loss, or necrosis. One patient suffered a postoperative complication after autologous fat grafting in the form of acute rejection that resolved with pulse steroids. CONCLUSIONS Secondary revisions after face transplantation are necessary components of care, as they are after most conventional free tissue transfers. Secondary revisions after face transplantation at the authors' institution have addressed both aesthetic and functional reconstructive needs, and these procedures have proven to be safe in the context of maintenance immunosuppression. Patient and procedure selection along with timing are essential to ensure patient safety, optimal function, and aesthetic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V. |
| Databáze: | OpenAIRE |
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