Evaluation of Facial Transplantation Without Motor and Sensory Nerve Repair

Successful functional and aesthetic results have been achieved with face transplants, especially for large or complex defects. However, patients must undergo long-term immunosuppressive therapy, which poses morbidity and mortality risks. Acute and chronic rejection episodes can result in skin discoloration and hardness. The aesthetic loss in our case occurred as mustache and beard losses owing to these rejection attacks. Facial mimic muscles have not been shown to be functional in all published facial transplant cases. Despite the lack of sensory or motor nerve repair, our patient regained normal skin sensation and most facial mimic muscle functions within the first postoperative year. Sensation is gained through nerve healing that develops from the grafts and flap base, in addition to sensory nerve repair. We believe that providing good contact of healthy mimic muscles in the recipient bed with the facial flap leads to successful aesthetic results, depending on intensive physical therapy.