Maximizing Neurovascular Outcomes of Facial Transplantation: A Comprehensive Review

Facial transplantation is a division of reconstructive surgery which aims to improve the function and appearance of a face that has endured severe disfigurement. Currently, the face transplant procedure uses allogenic tissue, harvested from a brain-dead donor, to replace damaged facial components. To date, 50 face transplants have been performed worldwide. Survival and functional success of the transplant is dependent on multiple factors; however, effective neurovascular recovery of the graft is arguably the most important. An effective vasculature system is essential to avoid necrosis and death of the transplanted tissue, and an effective nervous system is required for the graft to regain function. This comprehensive review examines and evaluates recommendations found in different studies to try and determine techniques for achieving optimal neurovascular graft outcomes. Sensory recovery of the graft occurs spontaneously through natural regeneration of the trigeminal nerve's cutaneous branches. Motor recovery, however, relies on precise coaptation of donor and recipient nerves using microsurgical sutures, reinforced by fibrin glue. Additional considerations, including parotid gland exclusion and use of a nerve graft, can further improve outcomes. Pre-operative vascular assessment of both the donor and recipient is another crucial consideration. Computed tomography angiography, magnetic resonance angiography, and digital subtraction angiography can be used to plan and enable successful end-to-end or end-to-side anastomosis of vessels. If applied in future facial transplantation procedures, these techniques could enhance recovery, improve functional outcomes, and lead to a greater patient quality of life.