Blood vessels reorganise after face transplants

Blood vessels in face transplant recipients re-organise themselves, leading to an understanding of the biologic changes that happen after full face transplantation.

Blood vessels in face transplant recipients re-organise themselves, researchers have found, leading to an understanding of the biologic changes that happen after full face transplantation.

The results of the study have been presented at the annual meeting of the Radiological Society of North America .

Face transplantation is a recent development in reconstructive surgery for patients who have lost some or all of their face from injury or disease. The first full face transplantation in the US was carried out at Brigham and Women's Hospital in Boston in 2011.

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 into the transplanted tissue.

Arteries and veins

 The development of new blood vessel networks in transplanted tissue is critical to the success of face transplant surgery.

 "We assumed that the arterial blood supply and venous blood return was simply from the connections of the arteries and the veins at the time of the surgery."
                
 Co-author Dr Frank J Rybicki,  director of the hospital's Applied Imaging Science Laboratory and his fellow researchers used 320-detector row dynamic computed tomography angiography (CTA) to study the facial allografts of patients one year after successful transplantation.

 The CTA technology offers imaging over 16cm of coverage, enabling the researchers to view collateralisation, a process in which the body stimulates existing blood vessels to elongate, widen and form new connections.

Larger vessels

"The key finding of this study is that, after full face transplantation, there is a consistent, extensive vascular reorganisation that works in concert with the larger vessels that are connected at the time of surgery," said another researcher, Dr Kanako K Kumamaru.

"We have found that since the vessels more commonly associated with the back of the head are critical to maintain the vascular reorganisation.”                    
The authors note that the findings could help improve surgical planning and assessment of potential complications in face transplant patients.

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