Renshaw, A.; (2011) Clinical considerations in facial transplantation. Doctoral thesis , UCL (University College London).

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Abstract

Facial transplantation has emerged as the next step on the reconstructive ladder for severe facial disfigurement. Clinical issues surrounding facial tissue donation are examined, comprising pre-transplant facial vessel delineation; pre-operative aesthetic matching; and attitudes towards donation. An anatomical study of 200 consecutive facial and transverse facial vessels was performed using colour Doppler ultrasound. Facial vessels were measured at three landmarks and their branching pattern documented. The facial artery main branch was detected at the lower mandibular border in 99.5% of cases, the accompanying facial vein in 97.5%. The transverse facial artery was present in 75.5% of cases, the vein found in 58%. When the facial artery was undetectable, there was transverse facial artery dominance. When the facial vein was absent it was replaced with a transverse facial vein. This provides valuable pre-operative information regarding vessel status. A quantitative eleven point skin tonal matching scheme is described using digital analysis of facial imagery. Attitudes towards tonal mismatch in facial and hand transplantation are examined in two representative skin types. There was more scope for skin tonal mismatching in skin tone 2 (slightly tanned white) than in skin tone 6 (light golden brown) participants. Tonal mismatches were more tolerated in facial than in hand transplant simulations in both groups. More acceptable donor tonal groups exist for males than females. Targeted matching of skin tone is thus required. Attitudes and beliefs of 170 transplant professionals were examined. Areas of concern included the organ retrieval process; impact on the retrieval team and donor family. In-depth analysis of a transplant donor focus group was performed; provision of information, posttransplant contact, and post-retrieval donor facial appearance was deemed important. A method of fabricating a donor-specific artificial prosthesis within the time frame of facial graft retrieval is described. Finally, a method of framing the informed consent process is described.

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