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World’s First Face and Hand Transplant Surgery Hailed a Success

World’s First Face and Hand Transplant Surgery Hailed a Success

the combined full face and double hand transplant procedure was divided into three critical portions in adjacent operatin grooms surgical teams worked to procure the donor face and hand allografts while reciprocal teams worked simultaneously to remove the damaged corresponding hand and facial soft tissues from the recipient the final phase involved the inside of the donor face and hands to the recipient for full restoration the donor facial incision extended along the lateral neck and posteriorly to include both ears soft tissue dissection proceeded toidentify the major blood vessels and nerves including the external jugular vein internal jugular vein external carotid artery and its tributaries internal carotid artery and the facial nerve while preserving its main trunk these structures were then carefully divided the scalp and soft tissues of the forehead were reflected forward and dissection proceeded down to the periosteal layer a prefabricated 3d printed patient-specific cutting guide was secured and used to guide bilateral frontal calvarial subunit osteotomies after preservation of the functional structures of the eyelids the supraorbital and infraorbital nerves patient-specific cutting guides werealso used to guide precisenasal frontal maxillary and zygomatic osteotomies these bony subunits were included in the allograft to maintain ligamentous and muscular attachments in their proper anatomical positions which ultimately provides for optimal facial function and aesthetics while preventing facial droop the mental nerves were carefully identified divided and included within the allograft to preserve sensation to the lower lip and chin a genial cutting guide was then placed and geniotomy was performed the vascular pedicles supplying the facial allograft were then clipped and divided
and prepared for transplantation concurrently the recipient underwent surgery to excise injured and scar tissues and recreate defects for precise adaptation of the donor face a hairline incision was used with subsequent removal of external scar tissue along the neck ears eyelids and face and the dissection of essential structures cutting guides were used to guide skeletal subunit osteotomies precisely matching those of the donor facial allograft corresponding mental nerves were divided and the geneatomy was performed using the operating microscope the donor and recipient external carotid arteries were anastomose end to end and the donor internal jugular vein was anastomose end to side with that of the recipient to restore profusion and drainage of the allograft rigid fixation was performed at the chin using low profile plates and the cut ends of the mental nerves were coapted the donor midface and orbital zygomatic bony subunits were affixed to those of the recipient using plates and screws followed by fixation of the frontal calvarial segments the soft tissues including the ears eyelids nasal and oral mucosa of the allograf were then redraped and tailored to the recipient recovery of the donor hands proceeded concurrently with the facial allograf procurement soft tissue flaps were raised taking care to preserve key anatomic structures which were tagged for identification the surgeons then proximally divided the median ulnar and radial nerves the superficial venous system including the cephalic and basilic veins the radial and ulnar arteries with their vena comatantes and the flexor and extensor muscle tendons which were taken at the musculotendinous junction the radius and ulnar were then exposed while protecting the neurovascular bundles and soft tissues pre-fabricated cutting guides were secured and the radial and ulnar osceotomies were performed the donor interosseus distance was adjusted to match that of the recipient simultaneously in the adjacent operating room skin incisions were made on the recipient’s forearms soft tissue flaps were raised and the underlying corresponding nerves superficial veins arteries and vena comatantes and flexor and extensor muscle tendons were dissected and tagged these structures were then divided distally in order to preserve maximal length prefabricated cutting guides were then applied to the radius and ulna and skeletal osteotomies were made in accordance with the computerized surgical plan osteosynthesis of the donor recipient bones was performed using rigid skeletal fixation plates microsurgical anastomosis of the donor and recipient arteries deep veins and superficial veins were performed restoring profusion and drainage microscopic coaptation of the median ulnar and radial nerves was completed the muscle tendons were then repaired systematically using a pulvertaf weave taking great care to balance the tension between flexor and extensor components for optimal hand function the skin flaps were then re-draped and tailored to achieve appropriate soft tissue coverage without excessive tension this marked the completion of the combined full face and double hand transplant for restoration following severe burn injury.

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