RECONSTRUCTIVE Restoration of the Donor after Face Graft Procurement for Allotransplantation: Report on the Technique and Outcomes of Seven Cases Julien Quilichini, M.D. Mikael Hivelin, M.D. Marc David Benjoar, M.D. Romain Bosc, M.D. Jean Paul Meningaud, M.D., Ph.D. Laurent Lantieri, M.D. Cre ´teil, France Background: After organ retrieval, restoration of the donor is a legal and ethical necessity; this is particularly true in facial transplantation. However, very few data are available regarding this procedure. Methods: This article reviews the seven facial masks produced during seven consecutive face transplants carried out at Henri Mondor Hospital in Paris, France. The time of production, morphologic outcome, and donor family feedback were recorded. Technical tips and pitfalls are also discussed. Results: Recording an impression of the donor’s face with alginate required less than 25 minutes and, in all cases, the production of a resin mask was completed before the surgical harvesting was finished. Although all morphologic results were satisfactory or very satisfactory, the best outcomes were achieved using a total face mask, avoiding color discrepancies. Family feedback was positive, and none of the funeral ceremonies was disturbed by the procedure. Conclusions: The production of a full-face resin mask is a reliable and reproduc- ible technique. This procedure restores donor integrity and gives a very satisfactory morphologic and aesthetic outcome. (Plast. Reconstr. Surg. 129: 1105, 2012.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. R estoration of the donor’s integrity is man- datory during any organ harvesting. In France, it is also a legal obligation required by the French Transplantation Agency for any fa- cial tissue sampling. 1–3 Restoration of donor facial integrity was one of the first considerations when facial allotransplanta- tion as a potential option for the treatment of major facial defects or deformities was considered. The French Transplantation Agency (Etablissement Franc ¸ais des Greffes), which oversees and controls tissue sampling in France, made donor restoration a prerequisite before any facial allotransplantation could be performed. In response, our first anatom- ical studies focused not only on harvesting tech- niques but also on restoration procedures. To date, 16 face transplants have been per- formed worldwide. However, very little informa- tion regarding donor restoration is available. In the various publications related to these interven- tions, the production of the donor mask is rarely mentioned, and the procedures and materials used to produce the mask are not specified. More- over, there is no information available on the mor- phologic results or on the technical difficulties related to these procedures. 4–7 During facial graft procurement, a mask is pro- duced to restore the donor’s original appearance. The aim of this article is to present the technique used for seven facial allotransplantations at the Henri Mondor Hospital, Paris. It also aims to iden- tify the pitfalls encountered and discuss the changes made to improve the morphologic and aesthetic outcome. The principles outlined in the Declaration of Helsinki have been followed. PATIENTS AND METHODS A retrospective study was performed of the outcomes and the difficulties encountered during the production of masks for seven facial allotrans- From the Department of Plastic and Reconstructive Surgery, Henri Mondor Hospital, and the XII Medical School, Uni- versite ´ Paris-Est Cre ´teil. Received for publication August 15, 2011; accepted October 24, 2011. The first two authors contributed equally to the article and should be considered as co–first authors. Copyright ©2012 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e31824a2bf8 Disclosure: The authors have no financial interest to declare in relation to the content of this article. www.PRSJournal.com 1105