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Major variations in branching patterns of the external carotid artery (3 types) and variations of the confluence of the facial, lingual, and superior thyroid veins with the internal jugular vein (5 types), described by Shima et al. 24 Descriptions of each variation are found in the Table.
Source publication
Facial allotransplantation replaces missing facial structures with anatomically identical tissues, providing desired functional, esthetic, and psychosocial benefits far superior to those of conventional methods. On the basis of very encouraging initial results, it is likely that more procedures will be performed in the near future. Typical candidat...
Context in source publication
Context 1
... When small neighboring vessels are not available, major neck vessels, such as the internal jugular system, can be used. 22 Another critical element of surgical planning is the identifica- tion of anatomic variants (Table and Fig 5). 24 Both arteries and veins can have a common trunk, leading to larger caliber vessels compared with the smaller individual vessels. ...
Citations
... In the past decades, modern imaging techniques have advanced the field of medical diagnostics and treatment planning, providing great insights into anatomical structures. Some of the more widely used are angiographic computed tomography (angio-CT) or angiographic magnetic resonance imaging (angio-MRI), which are appropriate imagistic techniques for describing vascular structures such as blood vessels, vascular abnormalities or variants and the structural modifications existent in complex tissular defects [87][88][89][90]. ...
The field of plastic surgery is continuously evolving, with faster-emerging technologies and therapeutic approaches, leading to the necessity of establishing novel protocols and solving models. Surgical decision-making in reconstructive surgery is significantly impacted by various factors, including the etiopathology of the defect, the need to restore form and function, the patient’s characteristics, compliance and expectations, and the surgeon’s expertise. A broad surgical armamentarium is currently available, comprising well-established surgical procedures, as well as emerging techniques and technologies. Reconstructive surgery paradigms guide therapeutic strategies in order to reduce morbidity, mortality and risks while maximizing safety, patient satisfaction and properly restoring form and function. The paradigms provide researchers with formulation and solving models for each unique problem, assembling complex entities composed of theoretical, practical, methodological and instrumental elements.
... Further optimization for higher resolution and deeper detection is beneficial to incorporate the context of the truly impressive resolution achieved by the present design into biological applications. What's more, a future study that could be worth including and considering would be to study subcutaneous vessel patterns and distributions for further medical applications, and to test the performance of the PAM device with the new micromirror design in real patients with the aid of a clinical or basic medical scientist and potentially verify how fine the resolution is in terms of the smaller vessels [33][34][35]. ...
In this paper, a portable photoacoustic microscopy (PAM) system is proposed based on a large stroke electrothermal micromirror to achieve high resolution and fast imaging. The crucial micromirror in the system realizes a precise and efficient 2-axis control. Two different designs of electrothermal actuators with “O” and “Z” shape are evenly located around the four directions of mirror plate. With a symmetrical structure, the actuator realized single direction drive only. The finite element modelling of both two proposed micromirror has realized a large displacement over 550 μm and the scan angle over ±30.43° at 0–10 V DC excitation. In addition, the steady-state and transient-state response show a high linearity and quick response respectively, which can contribute to a fast and stable imaging. Using the Linescan model, the system achieves an effective imaging area of 1 mm × 3 mm in 14 s and 1 mm × 4 mm in 12 s for the “O” and “Z” types, respectively. The proposed PAM systems have advantages in image resolution and control accuracy, indicating a significant potential in the field of facial angiography.
... Multiple connections exist between these angiosomes and across the midline, mainly by small-caliber choke anastomoses, especially in the scalp and superficial muscular aponeurotic system layer of the face. [8][9][10] Experience with facial allograft transplantation has shown that the angiosome of the ophthalmic artery at the central forehead and nasal dorsum can be supplied by reverse flow from the adjacent superficial temporal and facial artery territories. [8][9][10] Skin perforators of the main facial source vessels pierce the deep fascia at areas of skin attachment to the deeper layers, with a high density at the orbits, zygomatic arches, and root of the nose. ...
... [8][9][10] Experience with facial allograft transplantation has shown that the angiosome of the ophthalmic artery at the central forehead and nasal dorsum can be supplied by reverse flow from the adjacent superficial temporal and facial artery territories. [8][9][10] Skin perforators of the main facial source vessels pierce the deep fascia at areas of skin attachment to the deeper layers, with a high density at the orbits, zygomatic arches, and root of the nose. 10 These locations are common injection sites for fillers and fat grafting. ...
Background
Autologous facial fat grafting has gained popularity in recent years and is considered to be safe. We present the case of a patient who died due to massive cerebral micro fat embolism after facial fat grafting.
Objectives
Raising awareness and providing more evidence on prevention and treatment of this potentially lethal complication of facial fat grafting.
Methods
A detailed report was made of the case. Two online databases were searched for similar cases of facial fat embolism resulting in neurological and/or visual symptoms. Thereafter a literature search was conducted to verify the etiology, current treatment options, and preventive measures.
Results
Forty-nine cases with similar events were found in the literature. The most common injected area was the glabella (36.1%), and an average of 16.7 ml fat was injected. The main complications are visual impairment, of which 88.5 % remained blind, and neurological symptoms, who never fully recover. Seven cases were fatal. Fat embolism can occur in veins and arteries of the face. Two possible pathways for fat embolism exist: the macroscopic, mechanical pathway with immediate signs and the microscopic, biochemical pathway with delayed symptoms. Mechanical embolectomy and corticosteroids are suggested treatment options but lack evidence. Several different preventive measures are described.
Conclusions
Although facial fat grafting is considered a safe procedure, one should be aware of the risk for fat embolism. Underreporting of this adverse event is likely. With no effective treatment and often detrimental outcome, preventive measures are of utmost importance to improve patient safety.
... Each face transplant operation presents unique anatomical challenges, which have to be addressed on a case-by-case basis, including anatomic variation, recipient injury patterns, and prior reconstructive procedures; all of which result in differences in recipient osseous, soft-tissue, and vascular anatomy. 5,6 In the early days of VCA, most teams would identify a candidate and practice the operation on cadavers to understand the anatomical step-by-step maneuvers. This provides the opportunity to simulate and recognize the hurdles and results from the operation in a controlled setting. ...
Face transplant has rapidly advanced since the first operation in 2005, and to date, 40 partial or full-face transplants have been performed. The safety and efficacy of this operation are aided at all phases by supporting technologies. These include advanced imaging techniques to plan the operation, devices to monitor the flap in the immediate perioperative period, and noninvasive imaging and serum markers to monitor for acute and chronic rejection. Some of the technologies, such as those used in the immediate perioperative period, have extensive evidence supporting their use, whereas those to detect acute or chronic rejection remain investigational. The technologies of today will continue to evolve and make the operation safer with improved outcomes; however, the most significant barrier for face transplant continues to be immunologic rejection.
... Computer tomography/magnetic resonance imaging angiography is essential for planning vascular anasto- moses [38]. Branches of the external carotid artery can support the entire splanchnocranium [39]; however, fullface transplants can also be sufficiently supported by the facial artery [40]. ...
More than thirty-five facial allograft transplantations (FAT) have been reported worldwide since the pioneering case performed in France in the year 2005. FAT has received tremendous interest by the medical field and the general public while gaining strong support from multiple disciplines as a solution for reconstructing complex facial defects not amenable/responsive to conventional methods. FAT has expanded the frontiers of reconstructive microsurgery, immunology and transplantation, and established its place in the cross section of multiple disciplines. The procedure introduces complex scientific, ethical and societal issues. Patients and physicians are called to deal with a variety of - sometimes everlasting - challenges, such as immunosuppression management and psychosocial hurdles. This review reflects on the surgical and scientific advancements in FAT and milestones reached in the last 12 years. It aims to encourage active discussion regarding the current practices and techniques used in FAT, and suggest future directions that may allow transitioning into the next phase of FAT, which we describe as safe, reliable, and accessible standard operation for selected patients.
... The number of minimally interventional procedures has increased worldwide, and there are many studies that have shown a positive impact in the use of the 3D Computed Tomography Angiography (A-CT scan) for surgical planning in organ transplantation surgery [5,8,9]. Our institution is a Latin American reference hospital for advanced surgical procedures such as surgery of advanced stage cancers of the abdominal cavity and transplant of major organs such as the pancreas, liver and kidneys [10]. ...
... More advantageous is however performance of anastomosis in several vessels. Reconstruction of all available nerves must be performed the same way in order to achieve optimal motoric and sensory functions [33][34][35][36][37] . Reinervation of transplanted face occurs in approximately 18 months and from the day 10 there is a possibility to speak and eat. ...
Transplantation in reconstructive surgery has been performed for more than 20 years, although the official beginning of these procedures is considered the first successful transplantation of the hand in 1998. The original name "Composite Tissue Transplantation" has been used less frequently; more common is the term "Vascularized Composite Allotransplant", which better describes the basis of the procedure. There have been so far approximately 180 transplantations performed, the exact number is difficult to find. The most known transplantation from this group include transplantation of the hand and face, the other, such as transplantation of the abdominal wall, joints, bones, trachea, larynx, tongue, penis, uterus, etc. are less common and less well known. The common characteristics is that they are not used for salvage or prolongation of life, but to improve its quality. The quality of life is a value, which cannot be objectively measured and the opinions regarding its importance significantly differ. Therefore there is still an unsolved ethical issue regarding these procedures, which is based on the justification to use immunosuppressive therapy with its serious risks in cases when the procedure is not needed for salvage or preservation of life.
... Facial allograft transplantation restores form and function in patients with severe deformities [1] and is rapidly gaining acceptance for complex craniofacial reconstruction. Vascular anastomosis is critical to technical success, and thus pre-operative vascular mapping [2] plays a large role for a safer procedure [3]. Both Computed Tomography (CT) and magnetic resonance methods [4,5] have been studied for surgical planning [6]. ...
Recent studies have investigated the composition of compounds that cover the cuticle in social insects, but few studies have focused on solitary bees. Cuticular hydrocarbons may provide a tool for chemotaxonomy, and perhaps they can be used as a complement to morphology and genetic characters in phylogenetic studies. Orchid bees (Tribe Euglossini) are a highly diverse group of Neotropical bees with more than 200 species. Here, the cuticular hydrocarbons of 17 species were identified and statistical analysis revealed 108 compounds, which allowed for the taxonomic classification according to the genera. The most significant compounds discriminating the four genera were (Z)-9-pentacosene, (Z,Z)-pentatriacontene-3, (Z)-9-tricosene, and (Z)-9-heptacosene. The analyses demonstrated the potential use of CHCs to identify different species.
... Dedicated computed tomography (CT) examinations were performed at 6, 18 and 36 months after transplantation using a first-generation 320 Â 0.5-mm detector row scanner (Aquilion One; Toshiba Medical Systems, Tochigi-ken, Japan). Imaging details have been reported (6)(7)(8). For this project, 1 Â 0.5-mm (overlapping) reconstructed images were transferred to a dedicated workstation (Vitrea version 6.1; Vital Images, Minnetonka, MN). ...
Facial allotransplantation restores normal anatomy to severely disfigured faces. Although >30 such operations performed worldwide have yielded promising short-term results, data on long-term outcomes remain scarce. Three full-face transplant recipients were followed for 40 months. Severe changes in volume and composition of the facial allografts were noted. Data from computed tomography performed 6, 18 and 36 months after transplantation were processed to separate allograft from recipient tissues and further into bone, fat and nonfat soft tissues. Skin and muscle biopsies underwent diagnostic evaluation. All three facial allografts sustained significant volume loss (mean 19.55%) between 6 and 36 months after transplant. Bone and nonfat soft tissue volumes decreased significantly over time (17.22% between months 6 and 18 and 25.56% between months 6 and 36, respectively), whereas fat did not. Histological evaluations showed atrophy of muscle fibers. Volumetric and morphometric changes in facial allografts have not been reported previously. The transformation of facial allografts in this study resembled aging through volume loss but differed substantially from regular aging. These findings have implications for risk-benefit assessment, donor selection and measures counteracting muscle and bone atrophy. Superior long-term outcomes of facial allotransplantation will be crucial to advance toward future clinical routine. Volumetric measurements and histological assessment during follow-up confirm graft transformation after face transplantation. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
... 209 High spatial and temporal resolution vascular imaging is required to determine those vessels appropriate for arterial and venous anastomoses and usually includes computed tomographic vascular mapping of the external carotid distribution. 210 Computed tomographic angiography should be used as the first-choice modality for preoperative imaging of facial transplant patients because, when compared with magnetic resonance imaging, the visualization of small vessels is far superior and images have fewer artifacts. 211 Cine computed tomographic images were suggested by Sisk et al 212 ...
Disfigurement is more common than is generally realised. It can be consequence of trauma, cancer, radiotherapy, facial paralysis, birthmarks, vascular malformations, neurofibromatosis, cleft lip/palate and other craniofacial conditions.
Facial disfigurement can be physically, emotionally, and socially distressing, and some people whose faces have been disfigured can suffer a so-called “social death” which may instigate death by suicide. All the efforts should then be undertaken by reconstructive surgeons to improve the facial appearance and function.
In the chapter I, the social-psychological impact and common causes of disfigurement are analysed. Experimentally, we investigate different methods to evaluate patients with facial disfigurement, combining morphological analysis, functional and dynamic evaluation, as they may provide a measure of severity, progression of deformity and recovery of normal function (avatars and thermographic analysis).
In the chapter II, microsurgical autologous reconstruction of massive head and neck defects is first considered in a true clinical perspective, in parallel with new concepts of flap vascularization and harvesting principles. The role of chimeric free flaps and “their variations” in the context of limited vasculature and immediate oncological reconstruction is discussed. Regarding radiation and bisphosphonate induced mandible osteonecrosis, we describe different clinical situations related to several grades of osteonecrosis, where different options of free transfer should be considered based on patient-specific physiopathologic mechanisms. We propose a simple clinical grading system to predict the best treatment option. Facial reanimation of long-standing facial paralysis is also reviewed with focus on free muscle transfer. For the first time in the literature we describe facial reanimation in a blind patient. A new method for precise quantification of the characteristics of facial excursion pre-and postoperative is presented-facegram, with emphasis on smile analysis. This method focuses on the assessment of the trajectories of specific anatomical landmarks during rest and facial expressions. Measures based on the trajectories (position over time) of the anatomical landmarks cannot only evaluate abnormalities of spatial nature / topological, but can also assess temporal characteristics.
In the most extreme cases, conventional reconstructive options may be insufficient, and in chapter III, facial transplantation is investigated as a possible alternative. The definition and indications of Composite Tissue Allotransplantation (CTA) and technical aspects of facial allotransplantation are clarified. Adequate perfusion is crucial, but one of the most important aspects is related to allograft reinnervation; successful coaptation of as many major sensory and motor nerves is a key to optimize functional outcomes. Mock cadaver dissections are described and a new conceptual model for facial allotransplantation procurement is investigated; a transparotid dissection was not attempted before.
Finally, in chapter IV future perspectives in head and neck reconstruction are discussed, as well as the potential of facial transplantation to become clinical routine instead of experimental.
