Posted August 25, 2017

Daniel J. Ceradini, M.D., New York University School of Medicine
Eduardo Rodriguez, M.D., New York University School of Medicine

Severe craniofacial injuries are extremely difficult to repair with conventional reconstructive surgery. In addition to changes in appearance, such injuries create challenges like difficulty with speech, oral competence, and facial expressions, which can lessen quality of life. Vascularized composite allotransplantation (VCA) is a procedure in which many tissues (such as skin, fat, muscle, nerves, vessels, and bone) are obtained from a donor and transplanted to a recipient as a functional unit. VCA has become a viable treatment option to help restore normal function and aesthetic appearance in those who have been traumatically injured.

Drs. Eduardo Rodriguez and Daniel Ceradini and their colleagues at New York University School of Medicine are conducting a clinical trial of face transplantation that will develop "personalized" transplant techniques to improve the functional, aesthetic, and immunologic outcomes of patients who receive facial VCAs. The clinical team, led by Dr. Rodriguez, will design a personalized surgery for each of the patients, and each patient will receive an allograft containing significant pieces of vascularized bone from the donor's facial skeleton. The investigators hypothesize that, by transplanting fragments of bone along with critical ligaments of the face, the architecture of the face will be preserved. As a result, the recipient may experience more significant improvements in the way the face looks and functions over time. Drs. Rodriguez and Ceradini also hypothesize that the marrow transferred within the bone will help the recipient's immune system to develop tolerance and accept the donor's facial tissue. This is very important, as patients who receive a VCA must receive lifelong immunosuppression medication to prevent rejection of the transplanted graft. These medications can have adverse effects on the body. The personalized reconstructive approach developed by Drs. Rodriguez and Ceradini and their colleagues was used to successfully perform the most comprehensive face transplant reported to date.

Novel ways to optimize the functional and aesthetic outcomes of patients who receive VCAs, including face transplants, as well as ways to reduce the amount of immunosuppression that is required after receiving a VCA, are critical gaps in the field. The results of this clinical trial will greatly benefit candidates of life-enhancing VCA procedures, including injured Service members and others who have sustained devastating craniofacial injuries.

Publications:

Sosin M, Ceradini DJ, Hazen A, Levine JP, Staffenberg DA, Saadeh PB, Flores RL, Brecht LE, Bernstein GL, Rodriguez ED. 2016. Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Cadaver Simulation: The Culmination of Aesthetic, Craniofacial, and Microsurgery Principles. Plast Reconstr Surg. 137(5):1569-81.

Sosin M, Ceradini DJ, Hazen A, Sweeney NG, Brecht LE, Levine JP, Staffenberg DA, Saadeh PB, Bernstein GL, Rodriguez ED. 2016. Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Research Procurement: A Translational Simulation Model. Plast Reconstr Surg. 137(5):845e-54e.

Sosin M, Ceradini DJ, Levine JP, Hazen A, Staffenberg DA, Saadeh PB, Flores RL, Sweeney NG, Bernstein GL, Rodriguez ED. 2016. Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant: A Reconstructive Solution for the Full Face and Total Scalp Burn. Plast Reconstr Surg. 138(1):205-19.

Link:

Technical and Lay Abstracts for Utilizing Vascularized Bone to Improve Outcomes of Face Transplantation

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