Research Article| Volume 60, ISSUE 11, P1175-1181, November 2007

Download started.


Cadaveric comparison of two facial flap-harvesting techniques for alloplastic facial transplantation

Published:August 15, 2007DOI:



      Functional and aesthetic reconstruction of severe facial deformities presents a major challenge, and the results are rarely satisfactory. Recent clinical success of composite tissue allograft transplantation and improvements in autoimmune regulation have initiated efforts to reconstruct severe facial deformities with alloplastic tissue. Few reports address the full facial flap dissection approach, where lengthy procedural times remain a limiting factor in achieving optimal graft survival. Extensive vascular anastomoses within facial tissues provide a unique opportunity to explore alternative graft harvesting strategies to optimise operative ischaemia.


      The aim of the study was to shorten donor-graft harvesting time and reduce warm ischaemia. We evaluated alternative facial harvesting strategies through mock cadaveric facial transplantations.


      Cadaveric dissections were performed to explore facial-scalp reconstruction alternatives. Six paired sub-superficial muscloaponeurotic system (SMAS) plane composite facial-scalp flaps were harvested using either a superficial temporal artery (STA) or a facial artery (FA) pedicle technique (Group I) or an external carotid artery (ECA) pedicle technique. Total harvesting times and lengths of vascular pedicles were measured.


      Harvesting time for a STA and FA pedicle total facial flap (mean=113 min, range=105–120 min, SD=6 min) was shorter than that for an ECA pedicle flap (mean=232 min, range=225–240 min, SD=6 min) (P<0.01). Mean pedicle lengths for the STA, the FA, the ECA, the external jugular vein, and the facial vein were 37±2.1, 35±1.8, 26±1.4, 52±3.0 and 42±2.6 mm, respectively. Mean pedicle lengths for the supraorbital, supratrochlear, infraorbital, mental, and facial nerve were 15±1.5, 14±1.4, 24±1.2, 30±1.6 and 32±1.8 mm, respectively.


      Compared with previously reported ECA pedicle total facial allograft harvesting techniques, an STA and FA pedicle flap provides a shorter harvesting time and potentially safer dissection method for facial transplantation by avoiding interference with the complicated anatomy of the carotid and submental triangle. Early graft ischaemic damage can be minimised by this harvesting technique, which significantly shortens harvesting time compared with previously described approaches, while maintaining adequate full facial perfusion.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Francois C.G.
        • Breidenbach W.C.
        • Maldonado C.
        • et al.
        Hand transplantation: comparisons and observations of the first clinical cases.
        Microsurgery. 2000; 20: 360
        • Hofmann G.O.
        • Kirschner M.H.
        Clinical experience in allogenic vascularized bone and joint allografting.
        Microsurgery. 2000; 20: 375
        • Strome M.
        • Stein J.
        • Esclamado R.
        • et al.
        Laryngeal transplantation and 40-month follow-up.
        N Engl J Med. 2001; 344: 1676-1679
        • Levi D.M.
        • Tzakis A.G.
        • Kato T.
        • et al.
        Transplantation of abdominal wall.
        Lancet. 2003; 361: 2173-2176
        • Eguchi T.
        • Nakatsuka T.
        • Mori Y.
        • et al.
        Total reconstruction of the upper lip after resection of a malignant melanoma.
        Scand J Plast Reconstr Surg Hand Surg. 2005; 39: 45-47
        • Marck K.W.
        • Van der lei B.
        • Spijkervet F.K.L.
        • et al.
        The prefabricated superficial temporal fascia flap in noma surgery.
        Eur J Plast Surg. 2000; 23: 188-191
        • Heitland A.S.
        • Pallua N.
        The single and double-folded supraclavicular island flap as a new therapy option in the treatment of large facial defects in noma patients.
        Plast Reconstr Surg. 2005; 115: 1591-1596
        • Pallua N.
        • von Heimburg D.
        Pre-expanded ultra-thin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery.
        Plast Reconstr Surg. 2005; 115: 1837-1844
        • Kuzon Jr., W.M.
        • Jejurikar S.
        • Wilkins E.G.
        • et al.
        Double free-flap reconstruction of massive defects involving the lip, chin, and mandible.
        Microsurgery. 1998; 18: 372
        • Futran N.D.
        • Farwell D.G.
        • Smith R.B.
        • et al.
        Definitive management of severe facial trauma utilizing free tissue transfer.
        Otolaryngol Head Neck Surg. 2005; 132: 75-85
        • Copcu E.
        Trilobed skin flap on the face: for reconstruction of full-thickness or commissural defects.
        Dermatol Surg. 2004; 30: 915-921
        • Angrigiani C.
        • Grilli D.
        Total face reconstruction with one free flap.
        Am Soc Plast Surg. 1997; 99: 1566-1575
        • Mureau M.A.
        • Posch N.A.
        • Meeuwis C.A.
        • et al.
        Anterolateral thigh flap reconstruction of large external facial skin defects: a follow-up study on functional and aesthetic recipient- and donor-site outcome.
        Plast Reconstr Surg. 2005; 115: 1077-1086
        • Pribaz J.J.
        • Fine N.
        • Orgill D.P.
        Flap prefabrication in the head and neck: a 10-year experience.
        Am Soc Plast Surg. 1999; 103: 808-820
        • Pribaz J.J.
        • Weiss D.D.
        • Mulliken J.B.
        • et al.
        Prelaminated free flap reconstruction of complex central facial defects.
        Am Soc Plast Surg. 1999; 104: 357-365
        • Posch N.A.
        • Mureau M.A.
        • Flood S.J.
        • et al.
        The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects.
        Br J Plast Surg. 2005; 58: 1095-1103
        • Siemionow M.
        • Agaoglu G.
        • Unal S.
        A cadaver study in preparation for facial allograft transplantation in humans: part II. Mock facial transplantation.
        Plast Reconstr Surg. 2006; 117 ([Discussion 886–8]): 876-885
        • Siemionow M.
        • Unal S.
        • Agaoglu G.
        • et al.
        A cadaver study in preparation for facial allograft transplantation in humans: part I. What are alternative sources for total facial defect coverage?.
        Plast Reconstr Surg. 2006; 117: 864-872
        • Thomas A.
        • Obed V.
        • Murarka A.
        • et al.
        Total face and scalp replantation.
        Plast Reconstr Surg. 1998; 102: 2085-2087
        • Wilhelmi B.J.
        • Kang R.H.
        • Movassaghi K.
        • et al.
        First successful replantation of face and scalp with single-artery repair: model for face and scalp transplantation.
        Ann Plast Surg. 2003; 50: 535-540
        • Hui-qing Jiang
        • Xin-bao Hu
        • You-sheng Li
        • et al.
        Allograft transplantation with compound tissue of two ears and skin of head and neck.
        Chin J Plast Surg. 2003; 19: 416-419
      1. Editorial: the first facial transplant.
        Lancet. 2005; 366: 1984