Epidemiological and Surgical Insights Into Concomitant Ocular and Craniofacial Trauma and the Implications for Combined Face and Whole-eye Transplantation.

BACKGROUND

Concomitant ocular and facial trauma (COFT) can result in devastating functional, aesthetic, and psychosocial consequences, including vision loss. Standard reconstructive techniques often fall short in addressing the intricate needs of these injuries, making advanced techniques, such as combined facial transplantation and whole-eye transplantation (FT-WET), promising solutions. This study characterizes COFT patients to define a population that may benefit from FT-WET.

METHODS

A retrospective analysis of the National Trauma Data Bank (2018-2022) was conducted to identify COFT patients using International Classification of Diseases, Tenth Revision diagnosis codes. Patients were stratified into surgical and nonsurgical cohorts based on the presence of major surgical interventions targeting the face or eye. Characteristics of each group were compared.

RESULTS

Of 1,232,956 patients, 9640 (0.78%) experienced COFT, with 317 (3.28%) undergoing major surgery. Surgical patients were younger (41.9 ± 17.4 versus 50.6 ± 19.7 y, P < 0.001), predominantly male (80.1% versus 73.1%, P < 0.001), and more likely to have psychiatric comorbidities (16.4% versus 11.2%, P = 0.005). Firearm injuries (45.5% versus 7.53%, P < 0.001) and penetrating trauma (48.7% versus 9.14%, P < 0.001) were significantly higher in surgical patients. Severe injuries, such as globe avulsions (8.39% versus 1.41%, P < 0.001) were also more common in this group.

CONCLUSIONS

Surgical COFT patients represent a younger population with more complex injuries, aligning with favorable characteristics for potential FT-WET candidates. This study identified a distinct population of COFT patients who may benefit from FT-WET, providing critical insights into candidate selection and injury patterns.