Repair of a human face by allotransplantation.

摘要

The reconstruction of the body is a challenging task in medicine, especially when pioneering surgeons push technical frontiers forward to reach their vision for the benefit of humanity. Human nature reveals that individual steps are met with criticism which emphasises the status quo (or that which we feel safe in knowing). Bernard Devauchelle and colleagues have reached a new milestone by repairing a severely damaged face with a face allograft, as described in today's Lancet. The aesthetic outcome of the procedure, although not perfect, has proved better than that of conventional methods.Established techniques for repairing the human face use autologous local cutaneous tissue-flaps and free-flap autografts, which allow the transfer of more complex components such as skin, bone, and muscle. Local flaps, such as bilobed, nasolabial, or forehead skin-flaps, often produce good results in the face.But to reconstruct the face of the woman presented by Devauchelle and colleagues would have proved a major challenge to any surgeon. It is difficult to conceive that the same degree of success in the restoration of her complex perioral structures-including lips, nerves, and functioning mimic muscles-would have been possible with existing techniques. Another advantage in the technique presented is that the need to harvest autologous flaps isavoided; such harvesting produces secondary defects that might compromise the donor site severely.