The study was led by Darren Smith, plastic surgery resident at the University of Pittsburgh Medical Center (UPMC).

In face transplantation, facial tissue from a donor is transferred to reconstruct the defect, restore essential life-sustaining functions - such as breathing, chewing and speaking - and, above all, reestablish normal human appearance.

“This surgery is for patients with devastating injuries to the face, who have lost their ability to smell, eat and engage socially and have no other conventional treatment options,” said Vijay Gorantla, administrative medical director of the Reconstructive Transplantation Program at UPMC.

Currently, to prepare for facial transplantation, plastic or plaster models are first created based on 3-D CT or angiographic images or reconstruction. Following this, mock cadaveric dissections are performed to allow surgeons to plan for the donor and recipient surgeries. MRI and other imaging exams may also be used to provide supplemental information.

By combining information from multiple imaging tests and creating a sophisticated 3-D computer model, the researchers were able to assess the facial structure and contours, the underlying bone, muscles, nerves and vessels, as well as the extent of damage.

Using computer modeling software,  Dr. Smith and Dr. Gorantla, along with Joseph Losee, integrated information from 3-D CT, CT angiography, MRI and high-definition tractography to create a 3-D model of the patient's head and neck anatomy.

“We have integrated data from multiple imaging sources into a single 3-D representation that allows for real-time user interaction and modification,” Dr. Smith said. “In assessing eligibility for this procedure, it is critical to understand whether the patient has enough blood vessels and bone structure to support new facial tissue. This 3-D modeling helps us customize the procedure to the patient's individual anatomy so that the donor tissue will fit like a puzzle piece onto the patient's face.”

Using computer modeling, the study team also overlaid the patient model with a polygon mesh of a generic human face and then customized it to the recipient facial anatomy.

Dr. Smith said the ability to manipulate this 3-D facial envelope over the residual face model allows the entire surgical team to participate in planning exactly where bone, blood vessel and nerves will be cut and connected, as well as to evaluate the outcomes of reconstructive transplantation, including nerve regeneration within the transplanted facial tissue.

“The goal of face transplantation is not just structural,” Dr. Gorantla said. “It is about restoring function, so that patients are once again able to chew their food, smile and regain the most important aspect of a normal face - to look human.”

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