Technical and Anatomical Considerations of Face Harvest in Face Transplantation

In Brief Total face transplantation may become a reconstructive option in the treatment of patients with acquired facial deformity. Here, 2 face-harvesting techniques are presented in a fresh human cadaver model. In technique 1, the skin and soft tissue of the face is harvested by dissecting in a subgaleal, sub-SMAS, subplatysmal plane. In technique 2, the entire soft tissue and the bony structures of the midface are harvested by dissecting in a subperiosteal plane and performing a Le Fort III osteotomy. Each face was harvested successfully as a bipedicled flap based on the external carotid arteries, the external jugular veins, and the facial veins. Each of these 2 techniques is a theoretically viable approach to face harvest for composite allograft transplantation. These techniques represent the 2 extremes of which tissues can be harvested while maintaining vascular integrity. Each will address different reconstructive needs. Two techniques for full face harvesting were illustrated on cadavers. The first involved a skin and soft-tissue dissection in the subgaleal, sub-SMAS, subplatysmal plane; the second involved the entire soft tissue and bony midface in a subperiosteal plane with a Le Fort III osteotomy.