We begin today with a surprising follow-up on our most recent story about face transplants. According to the professional journal, Plastic Surgery Practice, “For the first time, researchers have found that the blood vessels in face transplant recipients do reorganize themselves a year after the surgery.”
Research and testing on three patients demonstrated excellent circulation within the transplanted tissue. Frank J. Rybicki, MD, PhD, FAHA, FACR, director of the hospital’s Applied Imaging Science Laboratory stated, “All three patients included in this study at Brigham and Women’s maintain excellent perfusion, or blood flow, the key element of viability of the facial tissues and the restoration of form and function to those individuals who otherwise had no face,”
As part of the procedure, surgeons connect the patient’s major arteries and veins to those from a donor face, to ensure healthy circulation in the transplanted tissue. “Because the technology is new, not much is known about the vascular changes that help blood penetrate, or perfuse, into the transplanted tissue.”

Orlando Cosmetic Surgery applauds and recognizes the significant factors of this remarkable research:

1. V.I.B.V. These are initials that mean Very Important Blood Vessels. “The development of new blood vessel networks in transplanted tissue is critical to the success of face transplant surgery.” It stands to reason that the new face must have blood networking through the tissue so that the muscles and skin, nerves and even bone can attain the proper form and function.

2. Out With The Old! The previous, old idea was that the arterial blood supply as well as the venous blood return were the sole result of the connections, called anastomoses, of arteries and veins created during the operation, by the surgeon. Doctors mistakenly assumed that the entire blood supply of the new face was totally the surgeon’s connections of the arteries and the veins.

3. In With The New! Now we know that the previous assumption is incorrect. Blood vessels branch out from their surgical connections, and new blood vessels net work their way throughout the tissue, both toward the front of the face and the back of the head. “The key finding of this study is that, after full face transplantation, there is a consistent, extensive vascular reorganization that works in concert with the larger vessels that are connected at the time of surgery,” Kumamaru says.

4. CTA Knowledge! Do not worry, these patients were not hurt when the blood vessels were investigated. Rybicki and Kanako K. Kumamaru, MD, PhD, a research fellow at Brigham and Women’s Applied Imaging Science Laboratory, utilized dynamic computed tomography angiography, known as CTA to “see” the blood vessels. “The CTA technology offers imaging over 16 centimeters of coverage, enabling the researchers to view the collateralization that often results from anastomoses, or branches formed between adjacent blood vessels.”

5. The New Facts!  Because of the new tests, one of the major things discovered in was the importance of healthy blood vessels associated with the back of thehead. They are judged are “critical to maintain the perfusion via vascular reorganization.”  This gives doctors an important clue to qualify a patient for face transplantation. The blood vessels at the back of the head should be intact and normal before the surgery.

The research has also improved surgical planning and understanding of the complications in this surgery. “Previous literature recommends the joining of multiple arteries and veins to ensure adequate blood flow in the facial allograft. However, performing these multiple connections causes longer operation time compared with a single anastomosis.” Now surgeons can shorten the long hours of time required by face transplant surgery, making the procedure safer for the patient.

A Winter Warning:  At this special time, with the weather here cooler, and with winter vacations upon us,

the doctors and staff of Orlando Cosmetic Surgery remind their friends, patients, and readers to protect their skin from winter wind and sun.  Don’t forget your muffler against the chill breezes, and continue to re-apply your sunscreen against the damaging UV rays of the sun!

We also extend our warmest, brightest wishes for your Christmas, Hanukkah, Kwanzaa, and New Year’s!   From Our Family To Yours:  Happy Holidays!