American Society of Plastic Surgeons
For Medical Professionals
 

Periorbital Transplantation May Be Promising Alternative to Protect Vision in Facial Transplant Candidates

Transplantation of the periorbital tissues—the area surrounding the eyes—is a "technically feasible" alternative to protect a functioning eye in some patients being considered for facial transplant, according to a study in Plastic and Reconstructive Surgery—Global Open®, the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).

The "periorbital subunit"—including the eyelids, underlying neuromuscular structures, and supplying blood vessels—may be transplanted as an isolated procedure or as part of a full facial transplant, report senior author Eduardo D. Rodriguez, MD, DDS, Chair of the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Medical Center and colleagues. They write, "The goal of periorbital transplantation is to re-establish protective mechanisms of the eye, to prevent deterioration of visual acuity, and to optimize aesthetic outcomes."

Periorbital Transplant—Initial Experience and Outcomes

The researchers present their approach to periorbital transplantation in five patients. All patients were being evaluated for face transplantation due to extensive destruction of the facial tissues—caused by a gunshot, animal attack, thermal or chemical burns, or cancer.

All patients had at least one functional eye, which was considered at high risk of deterioration due to loss of the eyelids and associated structures that protect the eye. The researchers explored the "indications and anatomic feasibility" of periorbital transplantation—transplanting the periorbital subunit alone or as part of a full face transplant.

After thorough evaluation and surgical planning, Dr. Rodriguez and colleagues proceeded to attempt transplantation of six periorbital subunits in five patients (including both eyes of one patient). Four patients underwent partial facial transplant including the periorbital tissues; the other patient underwent periorbital transplantation as part of a full facial transplant.

Transplants including critical periorbital tissues—such as the eyelids, tear ducts, and associated facial nerve branches—were obtained from deceased donors. In five out of six periorbital subunits, the surgeons were able to achieve a dual vascular supply to maximize the chances of tissue survival.

In four out the five patients, periorbital transplantation was successfully performed, reconstructing the lost tissue while restoring critical functions, such as voluntary and reflexive blinking. In the fifth patient, complications occurred.

While still controversial and performed at a small number of medical centers around the world, face transplantation has become an option for carefully selected patients with full or partial destruction of the facial tissues. Patients with intact eyes are at high risk of progressive deterioration due to loss of blinking and other protective functions.

"Periorbital transplantation (isolated or total face) is technically feasible," Dr. Rodriguez and coauthors conclude. They acknowledge some important limitations of their initial experience—especially the limited range of cases encountered in their single-hospital series.

The authors propose an approach to classifying the types of tissue loss that may be reconstructed by periorbital transplantation, and highlight key technical considerations involved in these complex procedures. They write, "Those patients with retained orbits, orbital nerve function, and early vision changes should be considered optimal candidates for allotransplantation in an effort to reverse the progression to blindness."

About PRS Global Open

Plastic and Reconstructive Surgery—Global Open (PRS Global Open) is an open access, rigorously peer-reviewed, international journal focusing on global plastic and reconstructive surgery. PRS Global Open educates and supports plastic surgeons globally to provide the highest quality patient care and maintain professional and ethical standards through education, research, and advocacy.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 93 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions and services for the clinicians, nurses, accountants, lawyers and tax, finance, audit, risk, compliance and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2020 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,200 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit www.wolterskluwer.com, and follow us on Twitter, Facebook, LinkedIn and YouTube.

Media Contact

ASPS Media Relations
(847) 228-3333
media@plasticsurgery.org

Logo

Patient Care Center