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Blood Vessels Restructure Following Face Transplantation Surgery

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According to a new study researchers, for the very first time, have discovered that blood vessels in face transplant beneficiaries rearrange themselves, leading to an understanding of the biologic changes that occur following full face transplantation.

Results of the study were presented at the annual meeting of the Radiological Society of North America (RSNA).

Face transplantation is a new phenomenon in reconstructive surgery for patients who have lost some or their entire face byway of injury or disease. The first full face transplantation in the United States was performed at Brigham and Women's Hospital in Boston in 2011. As a result, hospital specialists carried out full face transplantations on three additional patients.

In terms of how the procedure is performed, surgeons attach the patient's major arteries and veins to those from a donor face, or facial allograft, to guarantee healthy circulation in the transplanted tissue. Because the technology is quite new, very little is known about the vascular changes that help blood penetrate, or perfuse, into the transplanted tissue. The development of new blood vessel networks in transplanted tissue is vital to the success of face transplant surgery.facial-transplant

"All three patients included in this study at Brigham and Women's maintain excellent perfusion, or blood flow, the key element of viability of the facial tissues and the restoration of form and function to those individuals who otherwise had no face. We assumed that the arterial blood supply and venous blood return was simply from the connections of the arteries and the veins at the time of the surgery,” said director of the hospital's Applied Imaging Science Laboratory, and the study’s co-author, Frank J. Rybicki, M.D., Ph.D., FAHA, FACR.

To learn more, Dr. Rybicki and Dr. Kanako K. Kumamaru, M.D., Ph.D., research fellow at Brigham and Women's Applied Imaging Science Laboratory, used 320-detector row dynamic computed tomography angiography (CTA) to examine the facial allografts of the three patients one year following their successful transplantation.

The CTA technology provides imaging over 16 centimeters of coverage, allowing the researchers to observe collateralization, a course in which the body stimulates existing blood vessels to extend, widen, and establish new connections. Collateralization is often a product of anastomoses, or branches formed between neighboring blood vessels.

"The key finding of this study is that, after full face transplantation, there is a consistent, extensive vascular reorganization that works in concert with the larger vessels that are connected at the time of surgery," said Kumamaru.

Results revealed that the new blood vessel networks move posteriorly, or toward the ears and even farther behind the head, in addition to the large arteries and veins that move anteriorly in the face, or close to the jaw.

"We have found that since the vessels more commonly associated with the back of the head are critical to maintain the perfusion via vascular reorganization, it is essential to visualize these vessels and determine that they are normal pre-operatively. Patients under consideration for face transplantation have universally had some catastrophic defect or injury,” said Kumamaru.

The authors realize that the findings could help improve surgical planning and evaluation of possible complications in face transplant patients. For example, prior literature suggests the joining of several arteries and veins to ensure sufficient blood flow in the facial allograft. However, performing these numerous connections causes longer operation time as opposed to a single anastomosis.

"Our findings support the simplified anastomosis for full face transplant procedure that, in turn, can potentially shorten the operative time and reduce procedure-associated complications," said Rybicki.

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