Periorbital transplantation may protect vision in facial transplant
New USA based research has concluded periorbital tissue transplantation is feasible to protect eyesight in selected patients
The “periorbital subunit”—including the eyelids, underlying neuromuscular structures, and supplying blood vessels—may be transplanted as an isolated procedure or as part of a full facial transplant, according to new USA based research led by Eduardo D. Rodriguez, MD, DDS, Chair of the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Medical Center.
The study published in Plastic and Reconstructive Surgery—Global Open, details an approach that Rodriguez and colleagues have trialled on five patients being evaluated for face transplantation due to extensive destruction of the facial tissues—caused by a gunshot, animal attack, thermal or chemical burns, or cancer. All patients had at least one functional eye, which was considered at high risk of deterioration due to loss of the eyelids and associated structures that protect the eye. The researchers explored the “indications and anatomic feasibility” of periorbital transplantation—transplanting the periorbital subunit alone or as part of a full face transplant.
“The goal of periorbital transplantation is to re-establish protective mechanisms of the eye, to prevent deterioration of visual acuity, and to optimise aesthetic outcomes.” Writes Rodriguez.
After thorough evaluation and surgical planning, the researchers attempted transplantation of six periorbital subunits in all five patients (including both eyes of one patient). Four patients underwent partial facial transplant including the periorbital tissues; the other patient underwent periorbital transplantation as part of a full facial transplant.
Transplants including critical periorbital tissues—such as the eyelids, tear ducts, and associated facial nerve branches—were obtained from deceased donors. In five out of six periorbital subunits, the surgeons were able to achieve a dual vascular supply to maximise the chances of tissue survival.
In four out the five patients, periorbital transplantation was successfully performed, reconstructing the lost tissue while restoring critical functions, such as voluntary and reflexive blinking. In the fifth patient, complications occurred.
While still controversial and performed at a small number of medical centres around the world, face transplantation has become an option for carefully selected patients with full or partial destruction of the facial tissues. Patients with intact eyes are at high risk of progressive deterioration due to loss of blinking and other protective functions.
“Periorbital transplantation (isolated or total face) is technically feasible,” Dr. Rodriguez and coauthors conclude. They acknowledge some important limitations of their initial experience—especially the limited range of cases encountered in their single-hospital series.
The authors propose an approach to classifying the types of tissue loss that may be reconstructed by periorbital transplantation, and highlight key technical considerations involved in these complex procedures. They suggest, “Those patients with retained orbits, orbital nerve function, and early vision changes should be considered optimal candidates for allotransplantation in an effort to reverse the progression to blindness.”