2579: Face transplantation and the reconstructive management of the self-inflicted gunshot wound: An aesthetic, functional, and psychosocial report of 6 clinical cases

2579: Face transplantation and the reconstructive management of the self-inflicted gunshot wound: An aesthetic, functional, and psychosocial report of 6 clinical cases Harriet Kiwanuka, Mario A. Aycart, MD, David Gitlin, MD, Elaine Devine, LICSW, Bridget Perry, MS, Thet Su Win, MD, PhD, Ericka M. Bueno, Muayyad Alhefzi, Nicco Krezdorn, and Bohdan Pomahac, MD Brigham and Women’s Hospital, Boston, MA, USA; Mass General Institute of Health Professions, Boston, MA, USA Background Self-inflicted gunshot wounds to the face cause devastating midfacial defects, and pose a challenge to the reconstructive surgeon Face transplantation has the potential to provide near-normal restoration in otherwise non-reconstructable defects Two out of 7 face transplant recipients at our institution had sustained self-inflicted gunshot wounds We illustrate the role of face transplantation in the management of self-inflicted gunshot wounds through an aesthetic, functional, and psychosocial examination of outcomes. Methods We performed a retrospective analysis of individuals with self-inflicted gunshot wounds who were screened for inclusion in our face transplantation protocol between 2008 and 2015. We collected data describing the patients’ injuries, modes of conventional reconstruction, and deficits thereafter For those who received face transplants, we critically reviewed the psychosocial screening process and post-transplantation aesthetic, functional, and psychosocial outcomes. Results Six individuals postself-inflicted gunshot wounds were screened for face transplantation All had undergone conventional reconstruction, with 5 receiving loco-regional flaps and free tissue transfers, and one undergoing serial debridement and primary soft tissue repair All suffered from residual functional and aesthetic deficits Two underwent partial face transplantation at our center and one is currently undergoing screening We describe the pre-transplant psychosocial screening process and the aesthetic, functional, and psychosocial outcomes of the self-inflicted gunshot wound transplant recipients. Conclusions We examined the injury imparted by self-inflicted gunshot wounds to the face, outcomes of conventional reconstruction, and how face transplantation offers a potentially superior solution. More importantly, we highlight the critical nature of the psychosocial component of the multidisciplinary evaluation given the history of mental illness and suicidal behavior in this subset of patients CONTACT Harriet Kiwanuka hkiwanuka@partners.org Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/kvca. © 2016 Harriet Kiwanuka, Mario A. Aycart, David Gitlin, Elaine Devine, Bridget Perry, Thet Su Win, Ericka M. Bueno, Muayyad Alhefzi, and Bohdan Pomahac. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted. VASCULARIZED COMPOSITE ALLOTRANSPLANTATION 2016, VOL. 3, NOS. 1–2, 54–55 http://dx.doi.org/10.1080/23723505.2016.1234240