Patient expectations in facial transplantation

Leveraging Artificial Intelligence to Assess Perceived Age and Donor Facial Resemblance After Face Transplantation

PURPOSE

A major concern for patients undergoing facial transplantation relates to postoperative appearance. This study leverages artificial intelligence (AI) visual analysis software to provide an objective assessment of perceived age and degree of resemblance to the donor.

METHODS

Postoperative images of 15 face transplant patients were analyzed by Visage Technologies Visage|SDK™ AI facial analysis software to determine perceived age. A subgroup of eight face transplant patients, for which donor and patient pretrauma photographs were available, was analyzed using the same software to determine the percent similarity match to the patients' postoperative image. Mann-Whitney and Wilcoxon rank sum tests were utilized to evaluate for perceived age and facial recognition matching percentage, respectively.

RESULTS

AI perceived age was significantly more similar to the patient age (±3.5 years) than the donor age (±9.5, P = 0.0188). For facial resemblance, patients had a significantly higher average percent similarity match to their donor's face compared to their pretrauma native face (63% vs 57%, P = 0.0391).

CONCLUSIONS

Although patients more closely resembled their donor's resemblance posttransplantation, their perceived age correlated more significantly with their actual age than their donor allograft age. The findings of this study provide a helpful framework for counseling prospective patients on their expected appearance postoperatively.

A comparison of patient and surgeon preoperative expectations of spinal surgery

STUDY DESIGN

Cross-sectional study of agreement between patients' and surgeons' expectations of the outcome of spinal surgery.

OBJECTIVE

Patients' satisfaction after spinal surgery depends, in part, on whether their expectations of surgery are fulfilled. Whether the patient always fully understands the key messages conveyed by the surgeon, to formulate realistic expectations, is not known. This study evaluates the level of agreement in expectations declared preoperatively by the patient and the surgeon.

SUMMARY OF BACKGROUND DATA

Previous studies have investigated the importance of realistic expectations for the patients' satisfaction with surgical treatments, but there is still a need for a more detailed analysis in the field of spinal surgery.

METHODS

The study included 225 German-speaking patients (92 men and 133 women; mean ± SD [range] age, 62 ± 15 [15-90] yr) and their treating spinal surgeons (N = 7). Following the preoperative informed consent consultation, the patient and the surgeon independently completed a questionnaire about baseline neurological status and realistic expectations regarding various patient-orientated outcomes (axial pain (back/neck), radiating pain (leg/arm), pain medication usage, sensory and motor function, and the ability to work, do household activities, and play sports). Concordance was given by percent agreement and κ coefficients.

RESULTS

Agreement between the patient and the surgeon about the existence of spine-related neurological deficits occurred in 75% (sensory) and 61% (motor) cases. The patient but not the surgeon reported a sensory deficit in 20% cases and motor deficit in 35% cases; for 4% to 5% cases, the physician reported such a deficit that the patient was seemingly unaware of. The patients consistently had higher expectations than the surgeons, especially for back or neck pain and function (work, household activities, and sports); weighted κ values for agreement were low, ranging from 0.097 to 0.222.

CONCLUSION

The findings demonstrate wide discrepancies between the patient and the surgeon regarding the expected result of surgery. They highlight the need for clearer explanations of the association between the spinal problem and neurological deficits and the improvement that can be expected in pain and function after surgery. Systematic, routine evaluation of outcomes should assist in deriving the information necessary to document the improvement achieved and to formulate realistic expectations of surgery.

How to use outcomes questionnaires: pearls and pitfalls

Patient-reported outcomes serve as an essential and perhaps more relevant means for assessing patients' response to treatment than clinical measures alone. Many of the procedures performed in plastic surgery are associated with aesthetic outcomes. Therefore, it is pertinent to thoroughly understand the patient's perspective of achieved results. Surgeons need to possess knowledge and skills about outcomes assessments and understand how to apply them to improve quality of care delivered based on evidence. This article discusses the appropriate use of outcome questionnaires to rigorously evaluate treatment methods based on patient satisfaction and the outcome measurement instruments frequently used in plastic surgery.

Psychosocial changes 6 months after face transplantation

BACKGROUND

The goal of facial transplantation is to transform severely deformed features in a single, complex operation. Although nearly 20 have been completed since 2005, there is limited information about the subsequent psychosocial status of recipients.

OBJECTIVE

The purpose of this study is to describe such changes as captured on a variety of psychosocial measures 3 and 6 months after full facial transplantation among 3 adults who all completed a comprehensive psychiatric assessment before the procedure.

RESULTS

We hypothesized and found that participants experienced significant improvement on quality of life measures of physical and mental health based on the MOS-SF -12. While the recipients experienced a decline in their physical quality of life in the 3 months immediately after surgery, they had improvement by 6 months (p = 0.02). Overall mental health showed steady improvement from the time before surgery to 6 months later (p = 0.04). These changes, however, were not reflected in another popular measure of quality of life, the EQ-5D. There were no changes in participants ' self-esteem or dyadic function over the same period of time.

CONCLUSION

As facial transplantation evolves from being a novel surgical procedure to an increasingly common clinical practice, future efforts to delineate the psychosocial changes experienced by recipients might include mixed methods analyses, with both qualitative and quantitative data, as well as collaborative assessment protocols shared among facial transplantation programs.

A historical, clinical, and ethical overview of the emerging science of facial transplantation

In the past 5 years, a total of 16 facial transplantation surgeries have been performed in France, China, Spain, and the United States. Facial transplantation has become a surgical option in clinical situations in which soft tissue and bone loss is accompanied by severe cosmetic, sensory, and functional deficiencies due to disease, trauma, or congenital malformations. With the introduction of facial tissue transplantation surgery came complex clinical, technological, and ethical patient care issues. These complex issues included determining patient selection criteria, refining donor tissue procurement techniques, predicting expected functional outcomes, appreciating the limitations of obtaining a fully informed consent for an innovative procedure, and deliberating the immunological response and postoperative immunosuppressant requirements of the recipient. In addition, psychological implications for the patient, societal consequences, and ethical concerns have been discussed. The short-term results have been positive. Results to date indicate that the clinical, technical, and immunological patient care issues in this emerging science appear to mirror those of other reconstructive and organ transplantation procedures. The long-term physical, emotional, and psychological effects on the recipient patient, as well as long-term consequences to the donor's family, are yet to be validated.