A new option in reconstruction of severe facial injury

The world's first facial transplant has been reported in France (see News p 1359), but whether this signals the opening of a new frontier in reconstructive surgery depends on clinical outcome. Facial transplantation has long been recognised as technically challenging but clinically possible.1 The key area of debate is whether the benefit of this procedure to someone with severe facial deformity—in terms of improvement of function, aesthetics, and psychology—outweighs the risk of long term immunosuppression.

Two years ago the Royal College of Surgeons identified the key issues as patient selection, immunosuppressive risk, informed consent for an untried procedure, and psychological issues (notably altered identity).2 In the two years that have followed the college's report, considerable progress has been made in answering the questions it raised.

Selecting the right patients is paramount. The overall aim of this form of transplant surgery is twofold, as with any facial reconstruction: to facilitate …