Facial Transplantation: Surgical & Postoperative Care Guide
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Question: What is the recommended sequence for vascular anastomoses during facial transplant surgery?
Answer: Perform arterial end-to-end anastomosis on the external carotid artery first, then perform venous end-to-end anastomoses on the thyrolinguofacial trun
Question: Why is a superficial parotidectomy performed on the recipient during facial transplant procedures?
Answer: To find and distinguish upper and lower branches of the facial nerve, allowing tension-free motor nerve suturing.
Question: When are motor (facial) nerves sutured in facial transplant surgery and what limits their suturing?
Answer: Motor nerves are always sutured, but only if a correct superficial parotidectomy has been performed; individualized dissection of separate facial nerv
Question: Are sensory nerves (infraorbital and mental) always sutured in facial transplants? Explain limitations.
Answer: Sensory nerves are sutured only when available. In composite grafts that include bone this is often impossible because the nerves are contained within
Question: How does the surgical team manage nerve suturing to reduce postoperative hematoma and assist the repair?
Answer: They may use fibrin glue to aid nerve suture and act as a sealant to avoid postoperative hematoma.
Question: What challenges are associated with bony fixation in facial transplant surgery and how are they addressed?
Answer: Discrepancies between donor and recipient bones can make fixation difficult; careful preparation, multiple trimmings, and fixation with titanium plate
Question: What preparatory steps are important for mandibular transplant recipients?
Answer: Carefully prepare the recipient remnant, possibly liberate the masseter muscle, and section the bony attachment of the temporal muscle tendon as neede
Question: Which veins are typically found and used for venous drainage in facial transplantation?
Answer: Usually two veins on each side are found; venous drainage is mainly on the external jugular vessels and thyrolinguofacial trunks.
Question: How is venous drainage managed if superficial veins are not available (e.g., in burn patients)?
Answer: Anastomose the thyrolinguofacial trunk end-to-side onto the external jugular vein, creating a final anastomosis between the external jugular and the t
Question: What steps are taken when eyelids are transplanted during facial transplant surgery?
Answer: First create a dacryocystorhinostomy by drilling a hole in the lateral wall of the nose, pass lacrimal duct catheters into the nose, do this before su