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ANIMAL MODEL FOR FACIAL TRANSPLANT
After facial dissection in rats, rabbits, pigs and dogs, we found that the animal with facial vascular anatomy more similar to the human being was the dog. Before the surgical research, the arterial facial anatomy of the dog was studied in four animals. Then, a hemifacial SMAS-Skin island flap based in the facial artery and vein was raised including the muscles over the facial vessels by the nasolabial fold. The procedure was performed under general anesthesia, controlled by a veterinarian, in surgical conditions.
The flap was placed over the face again and sutured to the remaining tissues. The dog was maintained sedated and alive during 48 hours, controlling clinically the perfusion of the flap. Once sacrificed the animal, we took biopsies of the skin in the frontal, orbital (upper eyelid), oral commissure and cheek. We find clinically a survival of the 100% of the flap and no necrosis in the biopsies.
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ANIMAL MODEL: 1. Pre-operative picture of the dog, when is under general anesthesia. 2. The flap is raised under the SMAS including the orbicularis oculii muscle in the periorbital area. 3. The hamifacial flap is completely dissected leaving attached only the facial artery and vein, the dissection is performed deep to the angularis artery including part of the orbicularis oris muscle. 4. The flap is placed back, and sutured.
CONCLUSION
Against our initial excitement about the complete facial resurfacing with a single unit flap, we found the final outcome unsatisfactory because the quality of the transferred skin.
The complete hemifacial skin of the dog can be raised based just in the facial artery and vein. So we would be able to perform a facial transplant in dogs using just two pedicles, the bilateral facial arteries and veins
We strongly believe that the answer to the complete severe facial burns will be the facial transplant, and we have to do more research about it.
References
1. Angriniani C.; Total Face Reconstruction with One Free Flap. Plast. Reconst. Surg. 99;1566-75;1997.
2. Abraham T., Vijay O.; Total Face and Scalp Replantation.; Plast. Reconst. Surg.; 102:2085-87;1998.