Face Prefabrication For Total Face Restoration: An Innovative Approach & A Long-term Retrospective Study

PURPOSE: Total face restoration remains a challenge in modern reconstructive surgery. Face allotransplantation offers hope for patients, but several potential problems remain. After seventeen years of experiments and preliminary clinical studies, we developed a new concept of "face prefabrication" for face restoration with autologous tissue. METHODS: In this single-center long-term retrospective study, 32 patients who underwent total face restoration between 2005 and 2022 were reviewed. The total face restoration was accomplished with autologous tissue by combing skin expansion, integrated surgical and advanced imaging techniques. Three questionnaires, including the 36-Item Short Form Health Survey questionnaire (SF-36), Aesthetic and Functional Status Score of Facial Soft-Tissue Deformities/Defects (A&F) and the Euroqol 5 dimensions 5 levels questionnaire (EQ-5D-5L), were employed to evaluate the quality of life and satisfaction with facial esthetic and functional status. RESULTS: Twenty-four cases were included in this study with an average follow-up of 5.57 years (2-12 years). All patients reported a significant improvement in quality of life (SF-36), especially in social functioning and emotional stability. 91.67% of the patients went back to work. The facial esthetic and functional status also improved (4.96 pre-op vs 11.52 post-op; 11.09 pre-op vs 15.78 post-op, respectively, P < 0.001). In addition, there was a significant increase in overall satisfaction and self-reported health status. Major complications were partial graft necrosis in 2 patients. CONCLUSION: This innovative approach to total face restoration offered a safe and valid option for indicated patients with acceptable reconstructive and cosmetic outcomes.