Massachusetts Chapter of the American College of Surgeons

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Development of a New Large Animal Model for Composite Face and Whole-Eye Transplantation: Anatomical Considerations.
Miguel G. Bravo MD; Anna Rose Johnson, MPH; Bernard T. Lee, MD MBA MPH
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Background: Recent advances in this field of vascularized composite allotransplantation (VCA) have revolutionized the field of reconstructive surgery and demonstrated opportunity for restoration of orbital content and perhaps vision. The development of an appropriate animal model that would facilitate study of surgical technique, nerve regeneration, vision restoration, and immunosuppression is needed. The aim of this study is to describe three different flaps suitable for composite Face-Whole-Eye Transplantation (Face-WET) using a large animal model.

Methods: We studied three different flap designs using cadaveric Yorkshire swine and modified them for Face-WET harvest. Flaps harvested included a chimeric flap, Monobloc flap, and bipedicled free flap. We injected selected vasculature with dyed latex to better delineate vascular anatomy supplying the orbit and face. Indocyanine green was added to the latex solution to allow for visualization of the vascular supply and pattern using near infrared imaging.

Results: All three modified flap designs showed a well-defined and consistent vascular network within each Face-WET flap using laser-assisted near infrared (NIR) imaging.

Conclusion: In this study, we have presented the feasibility of the composite face-whole eye transplantation model, for the first time, using a large animal. Further study in large animals is needed to further appraise the surgical feasibility of this procedure and its potential for clinically relevant outcomes, including vision restoration. We believe this study will serve as a springboard towards human composite face and eye allotransplantation.

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USS Constitution
Paul Revere