Fundamentals of Facial Transplantation

Restoration of the central face—in particular, specialized structures such as the eyelids, nose, and mouth—presents a unique challenge for the reconstructive surgeon. The introduction of facial transplantation (FT), with the first clinical success in 2005, represented a paradigm shift in the management of complex central facial injuries previously untreatable via autologous methods. To successfully restore these structures, FT combines principles of craniofacial, aesthetic, and microsurgical fields. Alongside notable interventions such as hand, genital, and abdominal wall transplantation, FT belongs to a category of treatments called vascularized composite allotransplants (VCA) which are distinctive from solid organ transplants by their inclusion of multiple tissue types—such as skin, bone, and muscle. As a highly specialized and complex procedure, FT requires meticulous preparation, a comprehensive interdisciplinary approach, and careful patient selection to optimize reconstructive outcomes. In this chapter, we provide an understanding of FT candidacy, operative techniques, and patient management.