Soft-tissue deformities of the face and scalp may present as defects of a single component, such as skin, subcutaneous tissue, or muscle, or as defects of combinations of these parts. Extensive scalp loss due to burn or avulsion injuries is one of the most deforming and psychologically stressful conditions and creates a major reconstructive challenge. In case of severe tissue loss, it is virtually impossible to restore the normal appearance of the face and scalp. There is also deficiency of apt autogenous donor tissue sources with the desired texture and appearance required for optimal restoration of function and aesthetic. Thus, conventional facial restoration techniques might lead to skin discolorations, irregular textures, and perioral, perinasal, periauricular and periorbital contractures and cause an abnormal, expressionless and virtually mask-like face that is easily noticeable at conversation distance in most of the patients. These cases often require numerous reconstructive operations, nonetheless, the outcomes are not pleasing neither for the patient nor the surgeon.

After the first successful allogeneic hand transplantation in 1998 [21], various experimental and clinical studies of composite tissue transplants were performed for the reconstruction of the hand, knee joint, larynx, abdominal wall, tongue etc. [22–27]. These successful allotransplantation results opened the way for facial allotransplantation in human which was first performed in November 2005 in France by a team led by Professor Bernard Devauchelle and Professor Jean Michel Dubernard [28]. Since then, roughly 30 face transplantations have taken place in different parts of the world [29]. Though the surgical skills have been proven, the issue of immunotherapy remains as an obstacle essentially because this is not considered to be a lifesaving procedure [30, 31]. There are various defined experimental models for composite face/scalp reconstruction, including allogeneic transplantation [15–18, 23, 32–37]. Since there are some potential challenges during the allogeneic facial transplantation including the acute rejection, or failure of the anastomosis which would be a catastrophic situation, concomitant excision of the recipient’s own deformed face could be avoided. However the harvesting of the donor facial and/or scalp tissue is an emergent condition and cannot be delayed for a long time period. Thus would it be possible to harvest the donor facial tissues and keep them for a time period. It is not a probability to keep the harvested donor face in-vitro for a long time. Could it be possible to keep the harvested donor tissue at the body of the recipient in a heterotopic position? We know that the temporary ectopic replantation of the mutilated upper extremity before transferring to its original position was defined before and this technique is known as a babysitter procedure [20]. Is it possible to use babysitter procedure for the facial transplantation? To answer this question in an experimental fashion, we proposed to develop a heterotopic composite total face/scalp flap transplantation model in rats. We transplanted the harvested total face/scalp tissue of the donor rat to the back of the recipient rat. We preferred to transplant to the back of the rats to avoid auto-cannibalism. However, we think that anatomical factors will be more favorable among human subjects, for whom transplantation to the abdominal region could be possible without extensive morbidity and supplying a well hidden lower abdominal scar after the orthotopic transfer of the facial tissue. The scar would be as a tummy tuck scar. Moreover, during the partial facial transplantations the scar could be much shorter.