News | December 04, 2013

Blood Vessels Reorganize After Face Transplantation Surgery

ct systems rsna 2013 imaging

Aquilion One CT Scanner (left corner).

ct systems rsna 2013 imaging

Aquilion One CT Scanner (front table).

ct systems rsna 2013 imaging
December 4, 2013 — For the first time, researchers have found that the blood vessels in face transplant recipients reorganize themselves, leading to an understanding of the biologic changes that happen after full face transplantation. The results of this study were presented today at the Radiological Society of North America Annual Meeting (RSNA 2013).
 
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 United States was carried out at Brigham and Women's Hospital in Boston in 2011. Hospital specialists subsequently performed full face transplantations on three additional patients.
 
As part of the procedure, surgeons connect the patient's major arteries and veins to those from a donor face, or facial allograft, 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, or perfuse, into the transplanted tissue. The development of new blood vessel networks in transplanted tissue is critical to the success of face transplant surgery.
 
"All three patients included in this study at Brigham and Women's maintain excellent perfusion, or blood flow, the key element of viability of the facial tissues and the restoration of form and function to those individuals who otherwise had no face," said Frank Rybicki, M.D., Ph.D., FAHA, FACR, director, Applied Imaging Science Laboratory, Brigham Women’s Hosptial and co-author of the study. "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."
 
To learn more, Rybicki and Kanako Kumamaru, M.D., Ph.D., research fellow, Applied Imaging Science Laboratory, used 320-detector row dynamic computed tomography angiography (CTA) to study the facial allografts of the three patients one year after successful transplantation. The CTA technology offers imaging over 16 cm of coverage, enabling the researchers to view collateralization, a process in which the body stimulates existing blood vessels to elongate, widen and form new connections. Collateralization often results from anastomoses, or branches formed between adjacent blood vessels.
 
"The key finding of this study is that, after full face transplantation, there is a consistent, extensive vascular reorganization that works in concert with the larger vessels that are connected at the time of surgery," Kumamaru said.
 
Results showed that the new blood vessel networks course posteriorly, or toward the ears and even farther behind the head, in addition to the large arteries and veins that course anteriorly in the face, or close to the jaw.
 
"We have found that since the vessels more commonly associated with the back of the head are critical to maintain the perfusion via vascular reorganization, it is essential to visualize these vessels and determine that they are normal pre-operatively," said Kumamaru. "Patients under consideration for face transplantation have universally had some catastrophic defect or injury."
 
The authors noted that the findings could help improve surgical planning and assessment of potential complications in face transplant patients. For instance, previous literature recommends the joining of multiple arteries and veins to ensure adequate blood flow in the facial allograft. However, performing these multiple connections causes longer operation time compared with a single anastomosis.
 
"Our findings support the simplified anastomosis for full face transplant procedure that, in turn, can potentially shorten the operative time and reduce procedure-associated complications," said Rybicki.
 
Co-authors are Elizabeth George, M.B.B.S., Bohdan Pomahac, M.D., Michael Steigner, M.D., Geoffroy Sisk, M.D., Kurt Schultz, R.T., Dimitris Mitsouras, Ph.D., David Enterline, M.D., and Ericka Bueno, Ph.D.
 
For more information: www.rsna.org

Related Content

Report Finds Identifying Patients for Lung Cancer Screening Not So Simple
News | Lung Cancer | June 18, 2018
New findings in the current issue of The American Journal of Managed Care suggest that getting the right patients to...
Weight-Bearing CT International Study Group Hosts  Scientific Session at AOFAS Conference
News | Computed Tomography (CT) | June 15, 2018
June 15, 2018 —The Weight-Bearing CT International Study Group will host a scientific session on the benefits of weig
New U.S. Tariffs on Chinese Goods Include Imaging Equipment
News | Radiology Business | June 15, 2018 | Jeff Zagoudis, Associate Editor
The Office of the U.S. Trade Representative (USTR) released the much-anticipated list of Chinese-manufactured goods...
Florida Hospital First in State to Adopt NeuroLogica's BodyTom Elite CT
News | Computed Tomography (CT) | June 14, 2018
June 14, 2018 — NeuroLogica, a subsidiary of Samsung Electronics Co.
Riverain Technologies Issued U.S. Patent for Vessel Suppression Technology
News | Computed Tomography (CT) | June 14, 2018
Riverain Technologies announced that the United States Patent and Trademark Office (USPTO) has awarded the company a...
360 Photos | 360 View Photos | June 14, 2018
This is a 360 degree image from the Canon Aquilion 64-slice...
American Society of Neuroradiology Honors Peter Chang with Cornelius G. Dyke Memorial Award
News | Neuro Imaging | June 13, 2018
Peter Chang, M.D., current neuroradiology fellow at UCSF and recently recruited co-director of the UCI Center for...
NewYork-Presbyterian Expands Mobile Stroke Treatment Unit Fleet

Image courtesy of NewYork-Presbyterian Hospital

News | Stroke | June 11, 2018
NewYork-Presbyterian, in collaboration with Weill Cornell Medicine, Columbia University Irving Medical Center and the...
Latest additions to Somatom go. CT platform address advanced clinical fields and applications, including cardiology, CT-guided intervention and dual energy CT. How to lower radiation dose from Computed tomography scanners using ned technology.

Latest additions to Somatom go. CT platform address advanced clinical fields and applications, including cardiology, CT-guided intervention and dual energy CT.

Feature | Computed Tomography (CT) | June 04, 2018 | By Melinda Taschetta-Millane
Recent studies show a rapid increase in patient radiation exposure mainly due to increased use of medical imaging, pa
Lung Decision Precision
News | Lung Cancer | June 04, 2018
For smokers and former smokers, the threat of lung cancer always lurks in the shadows.
Overlay Init