*Purpose: Facial disfigurement is profoundly disabling, and great relief follows resolution by facial transplantation, now a technical reality at multiple centers worldwide. However, distance between potential donor and recipient is a significant obstacle in allograft availability, and cold-ischemia time constraints prevent in-depth cross-matching and pretreatment. Hypothermic perfusion has shown immediate functional benefit in transplanted kidneys, and oxygenation and brief subnormothermia have shown benefits in perfusion homogeneity in experimental hearts. Moisture-managing, ergonomic support surfaces are beneficial for skin tissue integrity. We have combined these elements anticipating an additive effect with the goal of improved face function and tissue viability at 24-hours preservation duration.

*Methods: We designed new functional modules onto an existing perfusion system including a heater for subnormothermia, perfusate oxygenation, and a perfusion bioreactor configured for faces. A swine hemi-facial flap was designed on a carotid pedicle. The flap was surgically mobilized, flushed, and placed into the pre-cooled perfusion machine with optimized perfusate. Pressure, flow, temperature, and perfusate chemistry measured at set intervals as subnormothermia maintained for 60 minutes at higher pressure followed by decrease in both. Chemical analysis is performed at set intervals and 24h weight and tissue samples are collected.

*Results: Successful swine hemifacial grafts were harvested containing muscle, bone, oral mucosa, and skin on a carotid pedicle. Adequate flap perfusion was confirmed with dye studies. After 24h perfusion, weight gain ranged from 6-16% with healthy appearing tissue. Chemical studies of glucose, lactate, and pH at 2h, 16h, and 24h was without significant increase in the study group when compared to control specimens. Histologic evaluation on H&E showed minimal skin changes with only minor myofiber fragmentation when compared to control samples. Immunohistochemical analysis for caspase-3 was without evidence of significant apoptosis.

*Conclusions: This study aims to show feasibility in achieving uniform perfusion, acceptably minor edema, and a viable, stable face graft suitable for transplantation following 24-hours’ preservation. This highly-translatable approach addresses key hurdles to prolonged Vascularized Composite Allotransplantation perfusion preservation. These technical elements for face preservation could be rapidly applied in potential face transplant recipients by implementing key modifications to existing clinical kidney perfusion systems.

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