Grants We Funded

Abstract
This proposed study is to define the neurovascular anatomy and specific technical issues for the harvest of functional composite flaps of the eyelid, nose, ear and upper and lower lips, as single, vascularized facial subunits. The facial subunits, which include the specialized tissues that makes up the ear, eyelid, nose, cheek, and upper and lower lips serves to define topographic areas with characteristic skin qualities, outlines, and shape. The subunit approach to facial reconstruction has been a useful principle to follow for concealing scars, maintaining skin qualities, and restoring symmetry. While microvascular free flaps can often provide tissue replacement for large defects, it has been less successful in restoring complex, specialized tissues such as the upper and lower lip. Therefore, the reconstruction of facial subunits that have lost tissues with specialized functions, such as the eyelid, continues to be an unsolved challenge. The ability to reconstruct these specialized tissues with the exact subunit from cadaveric sources would revolutionize the field of reconstructive surgery. Trauma, especially bums, to the face often leads to the loss of critical specialized structures such as the eyelids, lips, ears and nose .. Composite tissue transplantation of specialized subunits would allow for the transfer of tissues that could closely match the dimensions, texture, thickness, and function of any given facial defect. A near-normal facial appearance could be achieved in a single stage without any donor-site morbidity. The recent clinical transplants in France and China highlight the possible future use of these specialized transplants. The French patient had lost the upper and lower lips as well as much of the nose. These complicated structures were reconstructed in a single stage with no donor site issues. While there may be patients that require transplantation of the entire face, the majority of patients that will benefit from this CTA will need a segmental composite transplant. The goal of this study is to define the anatomic and technical issues surrounding these transplants. Preliminary studies that we have conducted show that it may be possible to raise a functional composite eyelid flap based on the transverse facial arterial system. Further study is needed to confirm these initial observations and show that such a flap can be harvested on a consistent basis.

Biography
Dr. Mathes is an Assistant Professor of Surgery in the Division of Plastic Surgery at the University of Washington in Seattle, and the Chief of Plastic Surgery Service at the Veteran’s Affairs Puget Sound Health Care System. He is also an Affiliate Investigator at the Fred Hutchinson Cancer Research Center in the Department of Transplantation Biology, where he conducts research on composite tissue transplantation. Dr. Mathes is certified by both the American Board of Surgery and the American Board of Plastic Surgery, and is a member of several national professional societies. He received his medical education from Tulane University Medical School in New Orleans, LA and completed his general surgery residency at New York Presbyterian Hospital, Weill-Cornell Medical Center, followed by specialized training in plastic surgery at University of Texas, Southwestern Medical Center. He has been published in a variety of peer-reviewed journals including Plastic and Reconstructive Surgery, Transplantation, and Microsurgery. His clinical interests include plastic and reconstructive surgery, reconstructive microsurgery, and cosmetic surgery. His primary research interests include the field of composite tissue transplantation and methods of inducing tolerance to foreign tissues. He has received several grants from such sponsors as the American Association of Plastic Surgery, American Society of Transplant Surgeons, Plastic Surgery Educational Foundation, and the American Society of Hand Surgery Research, and is currently pursuing Institutional Review Board approval for clinical research in face and hand transplantation.