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Abstracts: Commentary |

Evaluation of Facial Allograft Transplantation in Humans in a Cadaver

Mark K. Wax, MD; Eric M. Genden, MD
Arch Facial Plast Surg. 2007;9(5):366-368. doi:10.1001/archfaci.9.5.366.
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Traditional methods of reconstruction for extensive facial defects have relied on adjacent soft tissue transfer, regional flaps, and free tissue transfer. Adjacent tissue is often ideal because of the similar color and texture match; however, there exists a small segment of patients who have extensive skin defects that are not amenable to reconstruction with conventional reconstructive techniques. These defects, whether they are secondary to trauma, burns, or surgical ablation, present a challenging reconstructive paradigm.1 Prior attempts to reconstruct such defects with autogenous and allogeneic skin grafts have resulted in marginal outcomes. Contractures, sloughing, and infection limit these techniques, particularly in the periorbital and perioral regions. The concept of facial allotransplantation has the potential to provide a solution to many of these complex issues; however, it involves many social, psychological, and medical challenges. Unlike the tissues involved in cardiac, renal, and liver transplantation, the skin is considered one of the most allogenic human tissues. On the one hand, the high density of cutaneous antigen-presenting cells, namely, the dendritic cells, requires high doses of immunosuppression to prevent florid acute and chronic rejection.2 On the other hand, allogenic reconstruction with free-tissue transfer from the same patient obviates many of these complex tactics. Unfortunately, the composite structure of the face and scalp is complex enough that replacement by a single free-tissue transfer from another body part is not possible.

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