The four category systematic approach for selecting patients for face transplantation

Figures & data

Table 1. Demographic data.

Patient	1	2	3	4	5	6	7	8	9	10
Gender (M/F)	M	M	F	M	M	F	M	M	F	M
Age (years)	34	60	47	52	66	31	26	36	59	32
Age at injury (years)	18	41	29	N/A	26	22	NA	26	57	38
Mechanism of injury	Ballistic	Ballistic	Burn	NF1	Ballistic	Burn	Blunt	Burn	Burn	Burn
No of reconstructions	25	>20	20	7	34	N/A	N/A	10	4	9
No. of microvascular flaps	5	6	2	1	3	N/A	N/A	0	0	0

NF1: Neurofibromatosis 1; N/A: Data not available.

Table 2. Functional impairment evaluation.

	Patient	1	2	3	4	5	6	7	8	9	10
Oral	Mouth opening	Impaired	Impaired	Normal	Impaired	Restricted	Normal	Impaired	Normal	Impaired	Impaired
	Labial competence	Impaired	Incompetent	Impaired	Impaired	Incompetent	Impaired	Impaired	Impaired	Impaired	Impaired
	Teeth	Edentulous	Edentulous	Full dentition	Impaired	Edentulous	Full dentition	Full dentition	Full dentition	Full dentition	Full dentition
	Mastication	Soft nutrition	Soft nutrition	Normal	Soft diet	Soft diet	Normal	Normal	Normal	Normal	Normal
	Swallowing	Impaired	Impaired	Normal	Normal	Impaired	Normal	Normal	Normal	Normal	Normal
	Breathing	No nasal airway	Tracheostomy	No nasal airway	No nasal airway	No nasal airway	Slightly obstructed	No nasal airway	Normal	No nasal airway	Slightly obstructed
	Speech	Unclear	Unclear	Normal	Unclear	Impaired	Normal	Impaired	Normal	Normal	Normal
Periorbital	Eyelid function	Ectropium, lagophthalmos, enophthalmos, blind	Ectropium, lagophthalmos, enophthalmos	Ectropium, lagophthalmos, enophthalmos	No right eyelid (blind eye), right periorbital region normal	Normal	Normal	Impaired (ectropium, scarred eyelids)	Impaired (ectropium, scarred eyelids)	Normal	Impaired (ectropium, scarred eyelids)
	Visus	Blind	right: normal; left: impaired	Blind	right: normal; left: impaired	Normal	Normal	right: normal; left: impaired	Normal	Normal	Normal
Sensation	Forehead and scalp	Normal	Absent	Absent	Absent	Absent	Normal	Normal	Normal	Normal	Impaired
	Periorbital	Impaired	Impaired	Impaired	Absent	Impaired	Normal	Normal	Impaired	Impaired	Impaired
	Perioral	Absent	Absent	Impaired	Impaired	Absent	Impaired	Impaired	Impaired	Impaired	Impaired
	Cheeck and ears	Impaired	Impaired	Impaired	Absent	Impaired	Impaired	Impaired	Impaired	Impaired	Impaired
	Chin	Absent	Absent	Impaired	Absent	Absent	Normal	Normal	Impaired	Impaired	Impaired
Mimic muscles	Forehead wrinkling	Normal	Absent	Absent	Impaired	Normal	Normal	Normal	Normal	Normal	Normal
	Anger	Absent	Absent	Absent	Impaired	Absent	Normal	Absent	Normal	Normal	Impaired
	Smile	Impaired	Impaired	Impaired	Impaired	Absent	Impaired	Absent	Normal	Impaired	Impaired
	Mouth pucker	Impaired	Impaired	Impaired	Impaired	Absent	Normal	Absent	Normal	Impaired	Impaired
Sunnybrook	Left*	50	24	25	75	NA	NA	40	96	NA	50
	Right*	58	43	25	4	NA	NA	32	86	NA	46
	Severity (median score)
	Not relevant
0	Normal or near normal
1	Impaired
2	Severely affected or non-functional

NA: Data not available. * Maximum Sunnybrook score 100.

Table 3. Scores for aesthetic and quality of life impairment.

	Patient	1	2	3	4	5	6	7	8	9	10
Aesthetic disfigurement score*		7	7	9	8	5	4	8	4	6	7
QOL	EORTC HN-35	55	56	82	74	50	N/A	N/A	39	N/A	47
	15D**	0.656	0.854	0.533	0.791	0.872	N/A	N/A	0.843	N/A	0.914
	15D Control group median value***	0.949	0.925	0.93	0.944	0.918	N/A	N/A	0.95	N/A	0.949
	15D Difference in scores	–0.293	–0.071	–0.397	–0.153	–0.046	N/A	N/A	–0.107	N/A	–0.035
	QOL impairment score
	Normal or near normal
	Impaired
	Severely affected

*Scoring: 1: normal, 9: worst possible. **Values between 0 and 1; 1 representing full quality of life. ***Age- and sex matched comparison group 15D value in national population for each patient.

Table 4. Immunological status and potential contraindications.

Patient	1	2	3	4	5	6	7	8	9	10
Blood type	O+	O+	A-	B+	A+	A+	A+	O+	O+	A+
HLA-ab	Cl 1: B13, Cw 7	Class I +, Class II –	Class I –, Class II –	Class I –, Class II –	Class I +, Class II –	N/A	Class I –, Class II –	Class I –, Class II –	N/A	Class I –, Class II –
PRA	Cl 1: 13% Cl 2: 0%	Cl 1; 12% Cl 2: 0%	Cl 1: 1%, Cl 2: 0%	Cl 1: 0%, Cl 2: 0%	Cl 1: 23% Cl 2: 0%	N/A	Cl 1: 0%, Cl 2: 0%	Cl 1: 0%, Cl 2: 0%	N/A	Cl 1: 0%, Cl 2: 0%
Contraindications			Psych. issues		Psych. issues	Psych. issues	Psych. Issues		Alcohol
					Alcohol				Liver cirrhosis
0	Minimal preimmunization or no contraindications
1	Mild preimmunization or relative contraindications
2	Severe preimmunization or absolute contraindications

Figure 1. Affected anatomical facial regions.

Table 5. Summary of the four categories.

Patient	1	2	3	4	5	6	7	8	9	10
Affected anatomical regions
Functional defect
Aesthetic defect
Quality of life						N/A	N/A		N/A
Overall Score
	Mild deficiency
	Moderate deficiency
	Severe deficiency

N/A: Data not available.