Dr. Maria Siemionow and colleagues found that multiple operations could not restore disfigured structures and functions in their 45-year-old woman patient who survived a close-range shotgun blast to the face in 2004.

The patient underwent a near-total facial transplantation in december 2008, with a tailored composite tissue allograft used to replace 80% of her face.

The researchers found that the outcomes in patient were satisfactory during the postoperative period and tolerated immunosuppression without any major adverse effects. Routine biopsy on postoperative day 47 revealed rejection of graft mucosa, but this was effectively managed with just a single bolus of corticosteroids.

The patient got acquainted with her face in just first weeks and functional outcomes at 6 months were excellent. With transplantation, the patient had no difficulty to breathe through her nose, taste, smell, speak intelligibly, consume solid foods, and drink from a cup.

Conventional reconstructive techniques should be the main option when the surgical goal is skin coverage, the researchers emphasize. However, we have shown that in such extreme cases, face transplantation, although innovative, is a practicable alternative and should be taken into consideration as an early option, if only to spare a patient years of continued disfigurement, social ostracism, and the cumulative financial burden of multiple reconstructions.