Marston Miyazawa

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Summary.

The importance of rehabilitation after face transplant surgery is pointed out in a summarized way. It is necessary to inform the interested people in a simple way the steps of the rehabilitation and its effects so that they can make an informed decision about the surgery.

The subject is surgical rehabilitation and face transplant.

There is an abstract.

The importance of rehabilitation after the face transplant surgery is described in the summary. It stresses the need to report simple steps of rehabilitation and its effects on interested persons to resolve their doubts and to better psychological cope in surgery.

There are surgical rehabilitation, face transplantation.

The background.

The face transplant is one of the greatest achievements in plastic-reconstructive interventions, for patients with severe facial injuries. It provides an enormous benefit in terms of improved function and image.

Patients who are candidates for CDT, unlike other types of transplants, live in a situation of social isolation with serious limitations in their quality of life, determined by malformations in the most visible body area and linked to personal identity.

The TDC procedure presents important implications and challenges in the health and social field: on the one hand, the adequate selection and preparation of the people who are candidates for it, and on the other, that this type of intervention generates a great social debate, due to the ethical aspects that entails but also about the "myths", false beliefs that this type of procedure promotes in public opinion.

Medical, ethical, and psychological aspects play a central role in the preparation for surgery. Social factors must be considered in this type of transplant.

The concept of "Psychosocial" should be considered when considering the integration of psychologists in this field.

The objectives are.

The general objective.

Specific goals:

The introduction is about the basics.

One of the greatest achievements in plastic interventions is face transplantation, which is still in the experimental phase. It provides an enormous benefit in terms of improved function and image.

The improvement in quality of life is what distinguishes TDC from other types of transplants where saving the life of the patient is the priority.

The social debate opened from the first TDC promotes the idea of false beliefs about surgical techniques and also opens the question of the value of the image and the acceptance of the different aesthetic canons.

The field of intervention in this type of surgery values the management of expectations about the results, as well as the understanding of possible physical risks, such as rejection, in addition to the psychological aspects.

Research on the psychological aspects of organ transplantation is a starting point; but in the TDC, however, the issues of identity and alteration of the image (pre and post-surgical) and the adaptation to the changes, as well as the type of family and social network that the patient has, in addition to guaranteeing the follow-up on their integration community, are today an open field for multidisciplinary work. The goal is to improve the quality of care.

A transplant is a highly complex medical-surgical treatment that allows an organ, tissue or cell from a person to replace them in other people and in themselves.

The medical procedures for its realization began in the mid-twentieth century when the first successful transplant occurred. Rejection by the grafted organisms was the main problem that limited these techniques. Since then, research has focused on histocompatibility, for which immunosuppressive drugs were developed, which enhance it.

Micro-surgery techniques have made it possible to extend transplants to very complex tissues and organs.

The classIFICATION was agreed on.

The so-called "rejection" is one of the most relevant and frequent risks of interventions for allogeneic transplants, and there are different measures to minimize it.

The recipient of a transplant needs to be treated continuously throughout their life. The affectation of the immune system can lead to infections and other serious diseases that can affect the quality of life.

There are technical anomalies.

The technological advances in the field of microsurgery have made TDC viable, but some of the difficulties inherent in these procedures still persist.

The study of psychological and social aspects are included. Also on the ethical questions of the same, not only because of the conditions of the donor but especially because it is about the "face", which is more than the place where the perceptive organs are mostly housed, because it is the door to face-to-face interpersonal communication and the basis of identity, according to the psychosocial development of people.

Our social relationship is dependent on facial expression.

It is necessary to express a sense of "I". The brain and the facial muscles have an interaction.

The center of the person is their face, a unique and unrepeatable mark of identity, the basis for the creation of the "body image" from the earliest years.

The first partial face transplant took place in France in November 2005, and it started the media debate on this type of surgery. In December of 2008, the first almost total face transplant was performed in the United States.

There are circumstances in which the only option is an allogeneic transplant of facial skin taken from another human being.

The ideal donor must be a person with the same sex and age, and have the highest degree of tissue compatibility.

The texture and color of the skin should be similar to the recipient.

TDCs are not a matter of life and death as heart transplants are.

In TDC, an attempt is made to correct major facial disfigurements that lead to important functional sequelae and also psychological sequelae.

The patient selection process.

People with severe facial deformities want to recover lost function and a normalized facial appearance with a humanized gesture that does not cause rejection.

The inability to self-recognition is a consequence of the face's deformity.

The psychological repercussions are important, since facial alterations can lead to a change in identity.

It is not easy to integrate a transplant into one's body image immediately after surgery. From the experience of other transplants and the limited experience in TDC, it is known that this difficulty is greater at the beginning, when there is still no recovery of mobility or sensitivity in the transplanted area, and that the risks of "psychological rejection" increase when transplant patients cannot accept" the transplant as their own, in the evolution. Some hand transplants have been like this.

The medical criteria for selecting the right candidates for a TDC would be the first thing.

selecting the right patients is the most time consuming part of the process. Identifying the patients who could derive functional benefit and those who have realistic expectations about the procedure will be part of the process. The patient will need to be strong to cope with the physical and psychological challenges that they will face.

Rehabilitation in face surgery.

Treatment.

There are short term goals.

There are goals for the remainder of the year.

Increase tolerance to movements. Re-education of facial movements. Strengthening of the muscles.

There are long-term goals.

Reintegrate him into his daily living activities. Motor and sensory problems can be prevented.

Joint stiffness and vicious attitudes can be prevented. Joint mobility can be recovered.

TheRAPEUTIC PLAN

The first surgery is an amputation or a post surgery.

Once the edges are healed, massage can start.

A massage is done.

The purpose of the massage is to get the circulation going.

Favoring cell metabolism and stimulating muscle tissue trophicity. The psychological role to gain trust with the patient is an important part.

There is a lot of relaxation at the facial level.

The deep muscles of the bucinator and labial superior levator can be relaxed with the use of massage. It is accomplished with the help of two fingers and a thumb.

Circular pressures are used for it.

The massage is done in order.

The massage begins in the area between the eyebrows to the naso-genius chair, the wing of the nose, the upper lip, and then under the chin, where it ends towards the eyebrows.

After that, massage the frontal area, beginning with the temples, then sliding with light pressure of the fingers towards the axis of symmetry of the face and returning towards the temples in a light stretch, ending in the direction of the hair root.

The eye massage must be repeated at least 5 times.

It begins in the region between the eyebrows, moving through the upper eyelid to the outer corner of the eye and back to the root of the nose. The same massage is done in reverse and ends with stretching the skin of the outer corner.

A small pinch of the cheekbones was used to finish. It is important to perform the massage around the eyeball in support of the bone.

A stretch to the outside is followed by a lip massage.

There is also a massage that can be done at the beginning and end of the treatment that involves soft, slow and symmetrical passes on both sides of the face. Pressures are carried out with superficial sliding, local pressures and smooth rolling pinches.

The second stage is for redistribution.

The goal is to educate the patient about the movement of the fascia.

There are steps.

We are going to do it in this first attempt.

The assessment of the muscles.

The tone of the face should be compared with the opposite side.

The tone will be assessed.

He should be made to consciously resume the movement of his muscles.

It is done before the voluntary movement begins. The patient will have to perform certain gestures with the help of the therapist.

At the moment of the voluntary movement, it begins.

The active phase has help.

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